Editorial: a Dedication to Lisa Gebo by Steve Marson, Ph.D

Editorial: A Dedication to Lisa Gebo by Steve Marson, Ph.D.

Journal of Social Work Values and Ethics, Volume 7, Number 2 (2010)

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of White Hat Communications.

In the early 1990s, I met Lisa within her role of be saving paper! Within the following week, I senior editor for Brooks/Cole publishers when I received an e-mail from Lisa. The logo we laid out a proposal for a textbook addressing the currently use was attached. In the end, evaluation of generalist practice. Within our Brooks/Cole’s lawyers vetoed the concept, but discussions, we became sidetracked into the Lisa insisted that we retain the logo. She was technological aspect of relieved when she learned that White Hat practice evaluation. Two Communications had accepted the Journal of sidetracks are particularly Social Work Values and Ethics. note-worthy. At the BPD conference of 2006, Lisa announced First, using her to me that she had been diagnosed with Stage IV technological resources at breast cancer. She then started to ask me about Brooks/Cole, Lisa participated in at least six some personal problems I was having. My national conference presentations with the problems were trivial compared to what she Association of Baccalaureate Social Work relayed to me, and I was in a state of shock. Program Directors (BPD) Technology Since then, we communicated many times via e- Committee between the years 1996 and 2006. mail -- mostly through Faculty members learned what technological http://www.caringbridge.org . She wanted to advances the commercial world had available, autograph my copy of the Shameless Blues and Lisa learned what the professors liked--but Band’s CD. I still have it. more importantly, she learned what they needed. Lisa passed away peacefully at home at 9:54 a.m. Second, during this same timeframe, a on Monday, June 14, 2010, with her loved ones subcommittee was discussing the development of close at hand. Her charisma is dearly missed by an online journal for values and ethics. Lisa was those of us who had the pleasure of working with part of these early discussions and wanted her. Following are memorial statements made Brooks/Cole to be the publisher. During one of by her friends and colleagues: these early meetings, I mentioned that I was envisioning a green tree to ******************* be the logo for the journal. A tree would be a great Being part of Lisa's journey was, and is, symbol for an online a rich blessing and honor that is beyond journal, because we would words. She touched my professional life as

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Affective learning: A taxonomy for teaching social work values

Karen Neuman Allen, Ph.D., ACSW, LMSW Associate Professor, Social Work Program Director Oakland University

Bruce D. Friedman, Ph.D., ACSW, CSWM, LCSW Professor, Social Work Program Director California State University, Bakersfield

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of White Hat Communications.

Abstract domain, arguably the most complex, is rooted in the emotional life of the student and reflects Teaching in the affective domain is required the students' beliefs, attitudes, impressions, to facilitate development in the values, ethics, desires, feelings, values, preferences, and aesthetics, and feelings of social work interests (Friedman, 2008; Friedman & students. It is arguably the most complicated Neuman, 2001; Picard, et. al., 2004). type of teaching as it integrates cognition, Although social work education and behavior, and feelings. This paper presents an practice often stress critical components of the overview of affective learning as well as a affective domain, including values, attitudes, pedagogical taxonomy for use in designing ethics, and self-awareness, teaching typically and delivering instruction in the affective relies on cognitive learning strategies (Bisman, domain. A sample lesson plan used to teach 2004). This is due in part because the affective social justice and strategies for evaluating domain is poorly conceptualized, highly affective learning are also reviewed. individualized, and difficult to directly assess. In addition, the emphasis on standardized Social work educators have long testing, mastery learning, limited research, the recognized the responsibility to teach students lack of a consistent vocabulary and available in all three domains of learning: cognitive, instrumentation to study affective learning has behavioral and affective. The cognitive further contributed to its neglect (Kaplan, domain refers to learning and recalling 1986). Further, affective learning cuts across information and is often guided by Bloom’s all learning domains, incorporating cognitive taxonomy of cognitive learning (1956, 1964). and behavioral learning in addition to The behavioral or psychomotor domain exploring values and feelings (Kraiger, Ford & describes actual behaviors and skills that are Salas, 1993; Meyer & Rose, 2000; Picard, et. first practiced and then mastered by the al., 2004; Shephard & Fasko, 1999; Yorks & student (Simpson, 1972). The affective Kasl, 2002).

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve A value is a concept or an ideal that we and competence is an integral part of the feel strongly about, so much so that it professional socialization process. influences the way in which we understand There are two aspects of affective other ideas and interpret events. Values are learning. The first involves the learner’s preferences, and when the word is used as a attitude, motivation, and feelings about the verb, it means to prize or hold in high esteem learning environment, the material, and the (Rokeach, 1973). Many, if not most, social instructor, or conditions external to the learner. work educators incorporate content on Much of the research on affective learning has professional values in their courses, but an concerned itself with providing strategies to overarching pedagogical framework is missing enhance external conditions that promote (Friedman, 2008; Tyler, 2002). Understanding motivation, attention, and retention (Ainley, affective learning processes and the taxonomy 2006; Bye, Pushkar, & Conway, 2007; of affective learning can provide a useful Flowerday & Schraw, 2003; Keogh, 1998; framework for professional values education. Miller, 2005; Stone & Glascott, 1997). This is This paper will provide an overview of in part what the Council on Social Work affective learning, taxonomy of learning in the Education intends in its discussion of the affective domain, a sample lesson in teaching implicit curriculum that facilitates student about social justice and strategies for engagement by creating a supportive learning evaluating affective learning. environment (Council on Social Work Education, 2008). 1. Overview of Affective Learning However, this does not describe actual learning; rather it describes a student’s Affective learning involves changes in motivation and attitude about a particular feelings, attitudes, and values that shape learning experience. Actual affective learning thinking and behavior. Turk (2002) includes relates to feelings, attitudes, and values that personal and aesthetic development, as well as are identified, explored, and modified in some meta-learning in the affective domain, as these way because of the learning experience. It is relate to creating a desire for lifelong learning important to distinguish between attitudes and an appreciation for truth, beauty, and about a learning experience and actual knowledge. In discussing the professional learning, although in much of the literature on socialization of pharmaceutical students, affective learning these are poorly Brown, Ferrill, Hinton and Shek (2001) differentiated. For any type of learning to take explain that, “affective characteristics such as place (cognitive, behavioral, or affective), the motivation, initiative, compassion, service, student must be attentive, engaged, and accountability, empathy, honesty, advocacy, receptive. For social work education, we commitment, optimism, respect and self- assume that students are motivated in their confidence lead to behaviors that typically course of study and explore the affective produce professional excellence” (p.241). The domain to develop ways of designing Code of Ethics of the National Association of instruction that develops feeling and values Social Workers (1996, 1999) is founded on a congruent to the profession. preamble outlining social work values. For social work students, internalization of 2. Taxonomies of Learning professional values including service, social justice, the dignity and worth of the person, the The tripartite conceptualization of importance of human relationships, integrity, learning as cognitive, affective, and behavioral is particularly useful in social work education

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve as we strive to teach students the knowledge, Many educators are familiar with skills, and values of the profession (Ediger, Benjamin Bloom’s taxonomy of educational 2007; Menix, 1996; Yorks & Kasl, 2002; objectives (1956, 1964) in which a hierarchy Zimmerman & Phillips, 2000). While of learning outcomes is portrayed for the focusing on affective learning, for a cognitive domain. Using the taxonomy, comprehensive discussion, we review existing students are guided through successive stages taxonomies of learning in all three learning of learning through simple recall, domains. These taxonomies are also comprehension, application of the material, hierarchical, as each successive level of synthesis with other ideas, and critical thinking learning builds upon and expands the previous and evaluation. Although later models inverted level. We then compare and contrast the the fifth and sixth levels (Anderson & traditional taxonomy of affective learning Krathwohl, 2001), we present Bloom’s developed by Krathwohl (1964) with a revised original hierarchy of learning in Figure 1. taxonomy.

Figure 1. Bloom’s Hierarchy of Learning

Evaluation (Justifies, Critiques)

(Creates) Synthesis

(Distinguishes) Analysis

Application (Demonstrates, Uses)

(Predicts ) Comprehension

(Defines, Lists ) Knowledge

Bloom’s seminal work also included a responding, valuing, organizing, and hierarchy of affective learning (Bloom, 1956; characterization. Figure 2 presents the Bloom, 1964; Krathwohl, Bloom, & Masia, taxonomy of affective learning. 1964). David Krathwohl is credited with the model that includes five levels: receiving,

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Figure 2. Krathwohl’s Taxonomy of Affective Learning

Characterizing by a value (Influences, Questions)

(Orders, Synthesizes) Organizing

(Initiates, Reports) Valuing

(Conforms, Reacts) Responding

(Chooses) Receiving

The first two levels confuse the learns, and builds understandings, has been learner’s attitude, responsiveness, and changed rather than just isolated attitudes and attentiveness to the learning material with beliefs. We think of it as the character of the actual learning or changes in the student that individual is now different. Individuals who are the result of instruction (learning). It is not are characterized by an integrated, tested, and until the third level, valuing, that students justified system of attitudes and beliefs seek actually begin the process of learning as they out evidence before reaching a conclusion, compare and contrast new material with their follow a systematic process of inquiry, value existing ideas, beliefs, and attitudes. Students lifelong learning, put effort into enriching their at this level can articulate a value, defend it, understandings, and are often leaders because and describe its origin and rationale. They can they value contributing to others. also make judgments on the basis of this Bloom and his colleagues were not orientation. The fourth level that Krathwohl originally concerned with behavioral or identified, organization, describes the learner’s psychomotor domain believing that as college process of conceptualizing and organizing educators they had little experience in teaching their value systems in light of the affective manual skills. However, evaluating any learning that has taken place. A suitable learning requires observing behavioral changes metaphor might be to consider the way in in the student and most learning objectives are which a constellation is reconfigured when a behaviorally based. Simpson’s (1972) new star is discovered. The fifth and final level taxonomy of psychomotor learning describe of the taxonomy, characterization, refers to the behavioral changes from 1) perception and way in which an individual is now observation; 2) readiness and preparation to characterized by a generalized, comprehensive respond; 3) guided response through practice set of values and a philosophy of life and and demonstration while supervised; 3) learning. This is what Turk (2002) was, in mechanistic or automatic responses; 4) part, alluding to when he referenced meta- complex organization in which behaviors are learning and personal and aesthetic linked together into more intricate responses; development. and finally, 5) adaption in which the learner is At this level, the individual’s world able to appropriately modify what has been view, the way in which he or she explores, learned for use in novel situations.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Friedman, 2008). This model, presented 3. An Alternative Affective Learning below, assumes that the issue of gaining Hierarchy attention and assuring receptivity and motivation is a separate teaching concern that There is much here for educators in occurs in any and all learning situations. Krathwohl’s model. However, to our way of Whether teaching for cognitive, behavioral, or thinking there are limitations in its usefulness affective change, the teacher must employ for designing instruction largely due in part, to strategies to get and maintain the students’ a failure to distinguish between the learner’s motivation and attention. We have removed attitudes about the learning experience and this from the taxonomy of affective learning actual affective learning. Further, the model altogether and present it in Figure 3. In our does not directly suggest teaching strategies to experience, this model more easily lends itself facilitate movement through the sequence. to designing instruction that moves through Therefore, we propose an alternative successively more complex levels of affective taxonomy developed by Neuman (Neuman & learning.

Figure 3. Neuman’s Taxonomy of Affective Learning

The first level, identification, requires affective learning, it is appropriate to students to begin to identify and articulate reexamine earlier work in values clarification their own beliefs, values, and attitudes. at this stage, which were prominent in the According to Haynes (1999), the development 1970s and 80s. of values starts when students begin to Values clarification is a process critically examine their personal assumptions. originally described by Simon, Howe, and Therefore, it is necessary to teach students to Kirschenbaum (1972, 1973). According to the distinguish between ideas, cognitions, proofs, authors, to have fully expressed and and feelings and to recognize the uniqueness internalized a value an individual must: choose of their perspective as contrasted with others. it freely from alternatives, prize and affirm the At the second level, students clarify their choice, act upon the choice, and behave feelings and values and consider their sources consistently with the choice repeatedly over and implications. At these first two stages of time. Krathwohl’s hierarchy does not

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve specifically address the identification and modifies their original attitudes and beliefs clarification of values, implying that this about this type of client and the behavior so process is implicit in the learning process, that the student feels more positively toward perhaps occurring at the higher levels of the client and is more able to treat them with valuing, organization and characterization. respect and dignity. Which is preferable – However, if we consider identification and accommodation or assimilation? Although clarification as discrete steps in the process, some interpretation and personalization occurs teaching strategies are easily suggested. in professional education, the standardization, In the third level, students explore the consensus and regulation that defines a implications and limitations of their profession set real limits to the extent to which viewpoints and compare and contrast them an individual may assimilate and modify with others. For example, if a student defining principles of the discipline. acknowledges that they might have difficulty The final level, characterization, is working with an individual who behaves in a similar to the last two levels in Krathwohl’s certain way, we explore the sources and model. The student has developed an implications of this position. How does this fit understanding of their attitudes, values, within the profession’s value of respecting the beliefs, and feelings, and has organized them dignity and worth of the person? Will the into a coherent structure that now characterizes student be able to treat this individual in a the learner. The extent to which behavioral “caring and respect fashion mindful of consistency is demonstrated is a reflection of individual differences and cultural and ethnic the extent of internalization as well as diversity” while working to “promote socially maturity. responsible self-determination in the client”? In the fourth level, modification 5. Teaching in the Affective Domain occurs. Either the student alters in some way their beliefs, values, or attitudes or they The revised taxonomy easily lends modify the alternative position in such a way itself to guiding instruction to create learning as to be acceptable to them. Piaget (1952) experiences. We used the revised taxonomy described these two processes as assimilation for affective learning to create a learning and accommodation. In assimilation, new or experience around social justice. In the second external information generated in the session of a social welfare policy class, junior environment is modified to fit an existing students were asked to define what social internal, cognitive structure of the learner. In justice means to them. This is the first step of accommodation, the internal structure itself is the taxonomy – identification. They were modified to accept the incoming information. asked to explore where they learned this Working with the example above, if notion, the sources of this orientation, how the student is to assimilate the profession’s they came to believe it, and how strongly they values regarding the value of the inherent feel about it. This is the second level of the dignity and worth of each individual, s/he must taxonomy – clarification, which often includes interpret this new material so that it is “sourcing” where and how beliefs and values consistent with ideas already held. S/he may developed. Students were then given articles interpret the Code of Ethics to suggest that as on the topic, providing formal long as the client is treated with respect and conceptualizations of social justice such as dignity, s/he may continue to work with the distributive and restorative justice. The client in making more socially responsible instructor facilitated a discussion to identify, choices. If the student accommodates, s/he clarify and explore key concepts. They then

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve wrote a new definition. This is the fourth level forms of oppression for persons – modification. The students then worked in who face hardships.” groups to compare and contrast the various definitions (Level 3 – Exploration). They concluded the exercise by discussing their Student B. Definition Two beliefs and values about social justice and how these beliefs and values are important to social “Social justice is advocating work and influence practice (Level V- for and obtaining for Characterization). To highlight this exercise disadvantaged groups and we present two definitions from two students. persons equal access to resource, both monetary and Student A: Definition One otherwise by challenging, working with and working to “Social justice, overall to change the power structures me would mean that people and institutions that through have the ability to be free to their very existence create say and feel anything they and perpetuate various forms want about society but if of injustice and inequality. As they took action towards a social worker, it is my someone or something then desire to nullify these having laws about actions forces.” or word would be nice because people need These examples provide tentative boundaries so people can’t definitions of social justice. One set of go too far with something.” definitions describe characterizations of social justice, one can see that affective learning is still being measured through cognitive means. Student A: Definition Two The problem with affective learning is that it is difficult or nearly impossible to outright “Social justice is measure it without using either cognitive or advocating for equal rights psychomotor means. and opportunities for all people, no matter what 6. Evaluation of Affective Learning race, ethnicity or gender. It is connected to social work We recognize that it is easier to because social workers evaluate cognitive and psychomotor learning fight injustice, not because domains than it is to evaluate the affective they expect to eliminate it domain. Affective learning cannot occur but simply because it is absent ideas of cognition and cannot be known wrong and should not be except by observing behavior. We also tolerated.” believe it is the most complex and deepest kind of learning. Like cognitive learning, the Student B. Definition One most effective way to evaluate affective learning is through assessing objective, “Social justice means (to me) observed behaviors and expressions of the correcting and eliminating all learner. However, the difference is that one

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve evaluates within the context of a particular “the consistency with which one’s behavior values orientation (in the case, that of social matches an internal code of conduct or work) rather than just looking at performance schema.” of a specific skill. This is a critical notion for social work. Educational assessment typically When considering the extent to which a novice begins with the articulation of learning is socialized to the profession, we are, in objectives or outcomes (Anderson & essence, evaluating the consistency in which Krathwohl, 2001; Bloom, 1956; 1964; their behavior matches an established code of Greenland, 1991). Behaviorally-based conduct (Bisman, 2004; Haynes, 1999). objectives for affective learning can be Kaplan (1986) elaborated on written. Possible verbs to use when writing Krathwohl, combining with Bloom’s cognitive affective learning objectives include: defends, and psychomotor domains to develop the justifies, advocates, argues, accepts, Taxonomy of Affective Behavior or TAB. He challenges, promotes, rejects, shares, modified the levels of affective learning subscribes, verifies, and disputes. For slightly and created a complex set of example, “Upon completion of the course, worksheets in which to evaluate the extent to students will dispute the claim that poverty is which students were demonstrating affective always the result of character flaws or moral changes. For each of Krathwohl’s levels, failings.” Another example is, “Upon behaviors indicative of affective learning are completion of the course, students will identified and checked off when demonstrated. advocate policy changes that assure a For Kaplan, affective changes involved mechanism for financing affordable health cognitive and behavior components and also care for all individuals.” the frequency and intensity in which students Anderson and Krathwohl (2001) demonstrated the desired behavior. Boyd, identified four components necessary to Dooley and Felton (2005) modified this evaluate learning in the affective domain. The approach by doing a content analysis based on first component is the emotional quality Krathwohl’s levels to evaluate students’ observed in the student. For example, does the reflective writings after participating in an student’s tone of voice convey compassion? online simulation about global poverty. When advocating, is the student forceful? Although Krathwohl and Kaplan were Does the emotional quality of the student’s primarily developing their models of affective verbal expressions convey dismay when learning for use in teacher education, their confronted with an injustice? approaches have considerable applicability for The second component is the student’s social work and we pull from both models to willingness to attend or sensitivity and create our own system for assessment. Given awareness to the concept. For example, does the complexity of affective learning, the student consistently and quickly recognize assessment must involve evaluating cognitive, empathy or insensitivity? The third component emotional and behavioral demonstrations or involves the increasing automaticity of expressions on the part of the student. Because responses. Students at this stage have this is a professional degree program, we can incorporated the concept and skills into their look at the degree to which the student schema of practice and are beginning to comprehends key concepts of a professional internalize the concept. For Krathwohl, the value, the way in which they feel about it fourth and most essential dimension for (Krathwohl’s compassion and sensitivity) and evaluation of affective learning is the recognition that professional behavior is internalization. He defines internalization as

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve determined in specific ways by this demonstrates compassion, sensitivity and/or understanding. other appropriate expressions of affect, and Returning to the example provided identifies professional behaviors that are above on the student’s conceptualizations and consequently expected. feelings about social justice, we can create a Buchard (1991) used a Likert scale to general rubric that can be used for assessment. assess nursing students’ attitudes before and If we compare the first and second definitions after instruction as measured by performance (particularly those of Student A), we can see on affective learning objectives specified for that the second definitions more fully reflect the course. Because we think affective an understanding of advocating for equal learning includes cognitive and behavioral opportunities and resources for populations at elements in addition to affect, we are risk – key concepts in social work’s approach experimenting with a simple rubric for to social justice. This is the cognitive assessment. The student is assessed on the component. Both of the students' second quality of the cognitive content of their definitions incorporate an affective or, in this writings and comments, the extent to which a case, moral component. Student A talks about course of action or behaviors are suggested or “fighting injustice because it is wrong,” while demonstrated, as well as the identification of Student B strives to “nullify” the forces of feelings, values, ethics and moral obligations. injustice. Both definitions connect social Students are assessed as being weak, fair, or justice to the profession and indicate that strong along all three dimensions. Like advocacy behavior is expected on the part of Bucher, we recognize the real limitations of the social worker. Whereas we might not be this kind of scale but are finding it helpful in able to objectively “score” such an exercise, encouraging students toward a more integrated we could generally assess it by looking at the and comprehensive understanding of the extent to which the student correctly identified material. We are currently piloting the use of key concepts and principles (cognition), the following grading rubric.

Table 1. Affective Learning Assignment Grading Rubric

Domain Minimally meets Meets expectations Exceeds expectations expectations Quality of cognitive component Course of action, behaviors identified Articulation of feelings, values, ethics and/or moral obligations Congruency with professional ethics and values.

Another example in social work that behind it. We explain the importance of being involves the affective domain is the teaching supportive and accepting of our clients, while of empathy listening skills, which also working to promote positive changes. We includes cognitive and behavioral dimensions. review research studies evaluating the results When we teach empathy, we explain the of empathetically-based interventions and concept, as well as the research and theory expect students to be able to list and define the

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve key characteristics of empathy. This is in all three domains: cognitive, behavioral, and teaching in the cognitive domain. We explore affective. the affective component of empathy. We can begin by asking students to reflect on times 8. References when people were empathetic and not empathetic or supportive to them. What did it Ainley, M. (2006). Connecting with learning: feel like? What behaviors made them feel this Motivation, affect and cognition in way? How did they know the person was or interest processes. Educational was not being empathetic? How do they show Psychology Review, 18(4), 391-405. empathy in their lives? What does it feel like when they are being empathetic? We ask Anderson, L.W., & Krathwohl, D. (Eds.). students to reflect upon and describe their (2001). Taxonomy for Learning, feelings about the client and expect them to Teaching, and Assessing: A Revision of identify areas where they have difficulties. Bloom's Taxonomy of Educational Finally, we teach a set of behaviorally-based Objectives. New York: Longman. skills that include the use of open ended questions, verbal prompts, and nonverbal Bisman, C. (2004). Social work values: The behaviors that help students demonstrate their moral code of the profession. British ability to listen empathetically to their clients. Journal of Social Work, (34), 109 – Thus, the application of learning taxonomies 123. can guide instruction and facilitate the assessment of learning outcomes, particularly Bloom, B.S. (Ed.). (1956). Taxonomy of when teaching complex material such as educational objectives: The values, ethics, and aesthetics. classification of educational goals by a committee of college and university 7. Conclusions examiners. New York: McKay.

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Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve The NASW Code of Ethics under Attack: A Manifestation of the Culture War Within the Profession of Social Work

Sarah Buila Southern Illinois University

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of White Hat Communications.

Abstract political agenda” (Will, 2007). The critique is that the NASW Code of Ethics is A review of a sample (n = 55) of “ideologically loaded and mandating professional Codes of Ethics reveals that political advocacy and action” (NAS, n.d.). the profession of social work is unique in Hunter’s (1991) distinction between two taking the stance that social and political worldviews at war, the culture war, is used action are in the realm of professional to examine the attacks on the NASW Code responsibility. Recent criticism of the of Ethics as part of what is going on in our National Association of Social Workers’ broader society. This distinction is also Code of Ethics is framed as part of the used to clarify the profession of social culture war going on in society and this work’s position amongst the cultural paper raises questions about the battlefields and what the profession’s next profession’s role in perpetuating or move should be. perhaps ending the battle. Hunter (1991) describes two polarizing Key words: Culture war, code of ethics, “impulses” or worldviews, orthodoxy and social work, discrimination progressivism. Each has different visions of what is moral, good, right, and true. The 1. Introduction orthodox worldview ascribes to a “transcendent moral authority,” which The National Association of Social defines an “unchangeable measure of Workers’ (NASW) Code of Ethics has value” (Hunter, 1991, p. 44). Hunter recently come under fire as the means for (1991) points out that even the voices of “partisan declarations” within debates different faiths resonate in a commonality about policy (National Association of of the belief that the moral authority comes Scholars [NAS], n.d.) and as the from above and for all time. The articulation of the NASW’s “surreptitious progressive worldview ascribes to the “spirit of the modern age, rationalism, and

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve subjectivism” (Hunter, 1991, p.44). The Code of Ethics articulates ethical truth is viewed as a process and reality, principles based on social work’s core ever unfolding (Hunter, 1991). Regarding values. So does the NASW Code of Ethics moral or social issues, those who embrace align the profession to be exclusively on the orthodox worldview tend toward the progressive side? First, consider how political conservatism and those who diversity is defined by the identification of embrace the progressive worldview lean individuals or groups of individuals that toward the liberal agenda (Hunter, 1991). are oppressed or vulnerable to discrimination. At present, the NASW 2. Individual and Collective Code of Ethics identifies twelve Worldviews of Social Workers characteristics or attributes that have been and have the potential to be the basis of According to one study, social workers discrimination. These are race, ethnicity, affirm a progressive worldview (Hodge, national origin, color, sex, sexual 2003). Further supporting this contention, orientation, age, marital status, political another study found that although political belief, religion, and mental or physical diversity is welcomed, the more liberal a disability (NASW, 1999). Second, under social worker’s ideology, the more they the section titled Social And Political feel a part of the profession (Rosenwald, Action, Section 6.04c, “Social workers 2006). This study also found that the more should act to prevent and eliminate conservative political ideologies were domination of, exploitation of, and associated with a weaker belief in the discrimination against any person, group, NASW Code of Ethics. Collectively the or class on the basis of race, ethnicity, profession is viewed as always having had national origin, color, sex, sexual a clear progressive orientation (Hunter, orientation, age, marital status, political 1991; Hodge, 2003). Individually, social belief, religion, and mental or physical workers, as with the general public, hold disability (NASW, 1999). Third, under the views that fall on the continuum of beliefs same section, “Social workers should or worldviews and may be more or less engage in social and political action that liberal than the collective of social workers seeks to ensure that all people have equal represented by the NASW (Hodge, 2003; access to the resources, employment, Rosenwald, 2006). services, and opportunities. Social workers should be aware of the impact of the 3. The NASW Code of Ethics political arena on practice and advocate for changes in policy and legislation to and a Profession on the improve social conditions in order to meet Progressive Side of the basic human needs and promote social Culture War justice” (NASW,1999, section 604). The very inclusion of this section projects the Critics of the NASW Code of Ethics viewpoint that the world needs changing highlight the profession's commitment to and that even in the United States, there social justice, expectations that social remain people and groups that are workers take social and political action and “oppressed, dominated, or exploited.” that action is based upon a single partisan Furthermore, targeting policy and view (NAS, n.d.; Will, 2007). The NASW legislation for change is used to argue the

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve view that these are in fact mechanisms for dental, and mental health care fields and oppression and discrimination (Will, professions in the field of education. 2007). An example of the progressive worldview of the social work profession as 4.2 Data Collection articulated by the NASW Code of Ethics can be provided by looking to the code for The following questions were used for the guidance to address a battle currently being in-depth review: fought in the United States. Consider the debate over legislation that grants rights to 1) Does the professional code make a domestic partnerships. According to the statement of non-discrimination? NASW Code of Ethics, social workers a) If yes, which specific forms of should take political action to change diversity that should be the basis of policy to not discriminate or oppress non-discrimination are identified? individuals based upon their sexual orientation. Would any other profession 2) Does the professional code make a take on such a bold position? statement regarding the profession’s commitment to social justice? 4. Method 3) Does the professional code make a This study sought to answer the question: statement regarding the profession’s Is the profession of social work unique in obligation to social or political activism? its definition of diversity or a) If yes, what type of activism on recommendations for political and social behalf of whom? activism as articulated in the NASW Code of Ethics? 5. Results

4.1 Sample Of the 55 codes of ethics, 16 used the words non-discrimination or discriminate. With the assistance of The Center for the A total of 43 (78%) made statements to the Study of Ethics in the Professions (CSEP, effect that care should not be refused based n.d.), Index of Codes, the author conducted on certain attributes or statements calling and online review of approximately 700 for sensitivity or respect for diverse service professional Codes of Ethics. Of these, 55 recipients. Of these, 27 (49%) specify the were selected for more in-depth review. basis of non-discrimination. There were The sample selection was based upon the three that stated that discrimination for any profession’s status as having direct contact reason is unethical. The codes vary with in a helping or instructional capacity with respect to what they specify, however, race diverse and potentially vulnerable was specified for every code. Sex or populations. Additional professional codes gender was specified for most (24, 44%) were found conducting searches of this and religion, spiritual beliefs or preference data base using the key terms, social was specified for 22. Sexual orientation justice, diversity, and discrimination. was specified on 19 (35%). Age was These included professions in health, specified on 18 (33%). Disability was specified on 16 (29%), but only the NASW

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve and the Canadian Nurses Association of prejudice and stigma, and how that specify both mental and physical disability affects treatment of addiction. With this (NASW, 1999; CSEP, n.d.). There were 12 acknowledgement comes the charge of the (22%) that list socioeconomic status, 11 addictionist to advocate for changes in (20%) who listed culture, 10 (18%) listed policy to improve treatment and protect the national origin, 10 (18%) listed color, 9 rights of patients and families. The (16%) listed marital status, 8 (15%) listed Canadian Nurses Association states that creed, 6 (11%) listed language, and 4 (7%) nurses are obliged to uphold equity and listed gender identity or expression. There fairness… in promoting social justice were only 4 (7%), like the NASW Code of (CSEP, n.d.). Ethics, that listed political beliefs or affiliation. Numerous characteristics were Of the 21 professional codes that make a listed once or twice. These include: statement about the profession’s obligation immigrant status, special needs, health towards social or political activism, 10 status, life style, ability to pay, nature of (48%) are in reference to patient or client health problems, status or behavior of access to the type of services offered by parents, contribution to society, the profession, 4 (19%) make general appearance, moral, social and religious statements about improving the standards, status, reproduction status, community, and 8 (24%) make general inclination, circumstance, and feelings. statements about promoting the best Four listed other legal, unjustifiable, or interest, growth or development of the irrelevant reason. client, consumer, or patient. The National Society of Genetic Counselors “promote According to this review, four other polices that aim to prevent discrimination” professions make mention of obligations and take part in “activities to bring socially toward social justice. The Academy for responsible change” (CSEP, n.d.). The Certification of Vision Rehabilitation and Canadian Nurses Association states that Education Professionals’ Vision nurses should “intervene if others fail to Rehabilitation Therapy Code of Ethics respect the dignity of persons in care” states vision rehabilitation therapists (CSEP, n.d.). The International Council of “advocate for policies and legislation that Nurses (CSEP, n.d.), suggests, “Nurses can promote access, inclusion, social justice, work individually as citizens or equal opportunity and informed choice for collectively through political action to people with visual impairments” (CSEP, bring about social change” regarding n.d.). The American Society of Addiction health related socio-cultural issues such as Medicine, the American Psychoanalytic human rights. Association, and the American Psychiatric Association make statements in reference 6. Discussion to civil disobedience in protest against social injustices and that said actions might The NASW Code of Ethics is unique in the not necessarily constitute unethical articulation of ethical responsibilities in behavior (CSEP). The American Society of regard to social justice and social activism. Addiction Medicine acknowledges Based on this review, social work has the society’s response to alcoholism and other only code of ethics that explicitly states drug dependencies as reflecting a history

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve that the professional “should engage in Take, for example, the debate of domestic social and political action that seeks to partner legislation. This legislation is ensure that all people have equal access to viewed under the orthodox worldview as the resources, employment, services, and an effort to redefine the family and is opportunities they require to meet their therefore seen as an attack on Christianity, basic human needs and to develop fully. because it diverts from the “traditional, Social workers should be aware of the biblical family and marriage ideal” impact of the political arena on practice (Hunter, 1991, p.4). Whereas a gay couple and should advocate for changes in policy may have no intention of infringing or and legislation to improve social changing anything about a Christian conditions in order to meet basic human family’s lifestyle, by virtue of their needs and promote social justice” (NASW, differences, they are placed in the position 1999). of adversary. Having been discriminated against and oppressed, the person who is Furthermore, social work is the only gay may take offense against those who profession that articulates within a code of would block legislation to grant them ethics a commitment to challenging partnerships. A bitter seemingly discrimination with a list of specific irresolvable debate ensues, and when it vulnerable and oppressed persons or comes down to it, the social work groups and carries this responsibility profession is juxtaposed to advocate for beyond the realm of professional practice both sides (NASW, 1999). Considering the to the realm of society. The ethical Christian’s view as Hunter (1991) explains standard, Social, and Political Action it, the social worker should not oppress or (NASW, 1999, 6.04d) states, “Social discriminate based on religious beliefs. To workers should act to prevent and put forward this legislation asks some eliminate domination of, exploitation of, Christians or persons of the Orthodox and discrimination against any person, camp to change their definition of what is group, or class on the basis of race, moral and what is good, their world view. ethnicity, national origin, color, sex, sexual It asks them to accept a different definition orientation, age, marital status, political of what is right and true. beliefs, religion, or mental or physical disability.” In comparison to other Would most social workers side with gay professions, for social workers it is not couples who would benefit from such simply a matter of ensuring access to legislation? If we make the argument that social work services or for ensuring blocking domestic partnerships is a form of culturally competent practice; it is about discrimination based upon sexual changing the context in which services and orientation, then the Code of Ethics practice occur. informs us that we should act to prevent this discrimination. Can the argument be 6.1 How the Culture War Hurts made that this legislation is a form of discrimination against Christians based The culture war hurts when the rights of upon religious beliefs? Does asking a one group of people are seen as a violation person of faith to accept a different or attack on another group of persons. worldview in order to support policy and legislation exploit, dominate, oppress, or

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve discriminate against them? Some would better fit with the profession of social work argue it does set the stage for oppression despite the acceptance of political and domination of people of faith (NAS, n. (Rosenwald, 2006) and religious diversity d.). (NASW, 1999). Our values and principles are not meant to be used to exclude The culture war hurts when conflicts in persons of the orthodox or conservative worldviews combined with a power camp from entering the profession. It has differential lead to discrimination. The been argued that religious discrimination theory is that conflicting worldviews in exists within the social work education tandem with unequal power relations foster system (Hodge, 2006). It was accusations discrimination especially if the differences of religious discrimination in social work are unacknowledged (Hodge, 2003; education that added fuel to the fire of the Wambach & Van Soest, 1997). Bias is National Association of Scholars’ report, something that is embedded in a person’s “The Scandal of Social Work Education” worldview and it precludes discrimination. (n. d.). Perhaps anecdotal and not at all Given the power differential, which is representative to the population of social present between a social worker and client, work educators, the case histories, none the bias must be managed in the context of the less, consist of students who refused to helping relationship so as to not lead to participate in social and political activism discrimination (Zastrow & Kirst-Ashman, concerning “homosexual foster homes and 2007). One might argue that a person who adoption,” “abortion,” and “homosexual is racist, ageist, heterosexist, or sexist, for marriage” (NAS, n. d.). The grounds for example, would not make a good social refusal in all cases were the conflict such worker. When it comes to the potential actions would present with the students’ harm or discrimination of our clients or for religious beliefs and is therefore mistreatment of colleagues, this is a discriminatory. possibility. Bias and prejudice occur on a continuum, and we all have them to some 7. Implications degree. There is the social worker who holds strong prejudices and the social As social workers, we strive for social worker who, through naiveté or ignorance, justice, and this means accepting those to does not realize where he or she is on that the profession who may not have a liberal continuum of prejudice. Either can do perspective or a progressive worldview. harm. The first step toward doing no harm There are probably some bad or ineffective is awareness of personal prejudice or bias social workers out there, and whether or and awareness of how that prejudice or not they choose to take political action on bias has the potential to harm the very behalf of every one of the 12 different persons we aim to help (Zastrow & Kirst- sources of diversity identified in the Ashman, 2007). NASW Code of Ethics does not necessarily have anything to do with it. It is The culture war hurts when a profession conceivable that a social worker could such as social work is associated with one have an entire career practicing social side, and the worldview association is work, adhering to the standards of non- conceptualized as an absolute. Persons discrimination, and yet never take a with a progressive worldview may feel a

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve political action beyond voting. They may should be a wide variation of individual be very effective and help many people. If positions. Our diversity makes us better a social worker is in the position to and stronger. The worldview of one social advocate for a client who is oppressed, worker might make him or her better regardless of their differences, the social suited to work with and to advocate for worker may or may not be able to do this. certain clients. Individual social workers If a social worker’s worldview differs from can find their ideal niche within the that presented in our professional code, profession. If we did not have conflicting perhaps it is not too much to ask that the views from time to time, we might just social worker take steps to avoid the act of take our position for granted and allow it to discrimination. Just as a social worker go untested. Having differences within the might recognize an inability to help a profession prompts us to continuously certain client and refer that client to review and to reflect so as to reaffirm or someone else, they may do so in this revise our position as need be. As Graff circumstance. (1992) put it, we can turn our “conflicts into community.” He was speaking of Furthermore, it may not be realistic to university communities but this notion can expect every social worker to be working be expanded to the notion of a community as an activist for all individuals or groups of social workers. By listening to differing at once. It might make sense to expect viewpoints we learn from each other and social workers to pick and choose their we enrich our practice, our own viewpoints causes or battles. This is not to suggest any and our lives. A perfect way to become oppressed individual or group is more or attuned to our own biases is to have less worthy or that a social worker could dialogues with persons who have differing avoid taking social action altogether. Nor viewpoints (Bender & Leone, 1999). does it mean that social workers should neglect circumstances of discrimination 8. Conclusion when they become aware of them. The profession as a collective whole can take Social work is the only profession that care and advocate for all individuals articulates within a code of ethics a regardless of race, ethnicity, national commitment to challenging discrimination origin, color, sex, sexual orientation, age, with a list of specific vulnerable and marital status, political belief, religion, and oppressed persons or groups and that mental or physical disability. If social carries this responsibility beyond the realm workers find their beliefs in conflict with of professional practice to the realm of the political agenda of the NASW, then society. This is a profession to set they still have choices. They can choose to examples for other professions with a code not be a member or to speak out and enter of ethics that reflects values that can work a dialogue with the membership. toward putting an end to this culture war. Do we have room within the profession for The profession as a collective of social both sides of the culture war? Absolutely. workers has articulated its position within We need individuals from diverse the NASW Code of Ethics, and whereas backgrounds and worldviews to work to most may agree with this position (Hodge, prevent and eliminate social injustices. 2003; Rosenwald, 2006), there is and

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Isn’t that what we have been saying all National Association of Social Workers along? (1999). Code of ethics of the National Association of Social Workers. Retrieved August 24, References 2006 from http://www.soicalworkers.org/pubs/ Bender, D., & Leone, B. (Eds.). (1999). code/code.asp Why consider opposing Rosenwald, M. (2006). A part versus apart: viewpoints? In M.Williams (Ed.), The relationship between social Culture Wars Opposing Viewpoints workers’ political ideology and (pp.9-10). San Diego, CA: their professional affiliation. Greenhaven Press, Inc. Journal of Social Work Values and Center for the Study of Ethics in the Ethics, 3(2). Retrieved January 27, Professions (CSEP), Illinois 2008 from Institute of Technology, http://www.socialworker.com/jswv (n.d.).Codes of ethics online. e/ Retrieved December 18, 2007 from Wambach, K., & Van Soest, D. (1997). http://ethics.iit.edu/codes/ Oppression. In R. Edwards (Ed.), Graff, G. (1992). Beyond the culture wars: Encyclopedia of social work (19th How teaching the conflicts can ed., suppl. pp. 243-252). revitalize American education. Washington DC: NASW Press. New York: W. W. Norton & Will, G. (2007, October 14). Code of Company. coercion. Washington post.com. p. Hodge, D. (2003). Differences in B07. Retrieved December 31, worldviews between social workers and 2007, from people of faith. Families in Society: http://www.washingtonpost.com/w The Journal of Contemporary Human pdyn/content/article/2007/10/12/A Services, 84(2). 285- R2007101202151.html 295. Zastrow, C., & Kirst-Ashman, K. (2007). Hodge, D. (2006). Moving toward a more Understanding human behavior inclusive educational environment? and the social environment. A multi-sample exploration of Belmont, CA: Thomson religious discrimination as seen Brooks/Cole. through the eyes of students from various faith traditions. Journal of Social Work Education, 42(2), 249- 267. Hunter, J. D. (1991). Culture wars:The struggle to define America. New York: Basic Books. National Association of Scholars (n.d.). The scandal of social work education. Retrieved October 17, 2007 from www. nas.org/

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Kushner, Tomasine. (2010). Surviving Health Care: A Manual for Patients and Their Families. NY: Cambridge.

Reviewed by Ann M. Callahan, PhD, MSSW, LCSW, Assistant Professor of Social Work at Lincoln Memorial University in Harrogate, TN

Thomasine Kushner is a bioethicist at The ethical issues addressed are too the California Pacific Medical Center Program numerous and complex to review. However, in Medicine and Human Values. Co-editor of ethical issues related to end-of-life care are the Cambridge Quarterly for Healthcare discussed in several chapters of the text. The Ethics, she is author (with David Thomasma) issue of end-of-life care becomes particularly of Birth to Death: Science and Bioethics, salient when a patient is unable to consent to Asking to Die: Inside the Dutch Debate about treatment. This can make the treatment process Euthanasia, and Ward Ethics: A Case Book more difficult for loved ones, particularly for Doctors-in-Training. when a patient’s wishes have not been discussed or documented beforehand. This book is an excellent resource for anyone with questions about accessing health Hence, advanced planning is reviewed care. The work is comprehensive and yet not at length to show how individuals might overly technical. The editor includes chapters clarify what medical procedures are acceptable with numerous suggestions to prepare a health to prolong life and what defines an acceptable care consumer to address common health care quality of life that would justify the issues. The central theme is for consumers to continuation of care. There are templates for be informed so they can be more active in the paperwork that may be useful for the reader to treatment process as well as advocate for document health information, checklists that quality care. summarize additional considerations, and recommended steps to prepare for an Specific topics include selecting a emergency. doctor, understanding common treatment issues, engaging in the treatment process, and This book is most useful as a topical preparing for the end of life. The text also reference. As a whole, I believe the text would focuses on navigating the medical system benefit from a re-ordering of contents, during treatment for medical emergencies, perhaps, along the continuum of care. There transplantation, psychiatric illness, could be the addition of chapters to address Alzheimer’s disease, terminal illness, and common medical events such as pregnancy, natural/human disasters. Finally, medical cancer, and stroke. It would also be helpful to issues specific to children and elders are include more discussion about health addressed with ethical issues that can arise conditions, access to healthcare, and during the provision of medical care addressed healthcare processes that may vary relative to throughout the book. patient gender, race, or religion.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve In summary, this book is an excellent reference on health care issues that can be used resource for social work students, over and over again. This book also presents practitioners, and educators interested in ethical issues that are central to the delivery of medical social work. The material included in health care, which, given their complexity, can this book provides a comprehensive, but quick, be used to stimulate further discussion.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Conflict Between Professional Ethics and Practice Demands: Social Workers’ Perceptions

Nancy Gallina, Ph.D. Touro College

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of White Hat Communications.

Abstract client needs and attending to This study examined the degree to environmental forces that create and which social workers perceived contribute to their problems, and, requires experiencing ethical conflicts in the that social workers place service to others contexts of their practice environments. A above self-interest, provide access to sample of 376 NASW members filled out services for all who need it, and challenge questionnaires to report on a Likert scale social injustice (preamble). The market the degree to which eight vignettes forces, which have become apparent since describing practice situations presented a the 1990s, include reduced funding for value conflict, were frequent, and were human services, the decrease in federal inevitable. Findings indicated that welfare provisions, delegation of service respondents tended to view most situations delivery to states and cities, and, tighter as creating an ethical conflict and eligibility requirements for services (Brill, infrequent. Financially-related situations 2001). were seen as inevitable more often than As funding became scarce because of others. Findings are discussed and conservative tax policies and human implications for the profession are offered. services dwindled in tandem with tighter eligibility requirements, the government Keywords: Ethical Dilemmas, Values, began to privatize its services in an effort Mission, Market to become more fiscally prudent (Beresford, 2005; Munger, 2006; Zullo, 1. Introduction 2006) and practice started to be driven by In making professional decisions, funding sources such as managed care social workers are currently caught (Alegria, et al., 2001). For example, between two conflicting sets of demands, employment and foster care services, once one informed by the mission of the offered by the Department of Social profession and the other by market forces. Services, are now being provided through The professional commitment is guided by individual agencies in the nonprofit sector the NASW 1996 Code of Ethics, which (Zullo, 2006). The move to outsourcing of describes social work’s mission as meeting service delivery to the private sector using federal and state grants and contracts led to

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve government’s increased vigilance over Reisch & Lowe, 2000). Consequently, funding and the demand for accountability social workers have been positioned in a and evidence-based practice. The push for situation of “dual citizenship” with fiscal solvency among the nonprofits has conflicting demands resulting from their grown and requirements have become professional and organizational affiliations. more rigid with demand for demonstrated As members of the professional outcomes, to the degree that some grants community, they are obliged to follow delay the release of funding until outcome NASW Code of Ethics, whereas targets have been met (Abramovitz, 2005). administratively, they need to follow the The aforementioned changes in the guidelines of managed care companies or practice environments require social work their government and nonprofit agency settings to augment their performance employers. (Schneider, Hyer, & Luptak, 2000), as well This position increasingly creates for as provide a growing amount of social workers a role conflict, i.e., a documentation relative to utilization rates, situation in which societal standards, client outcomes, and capitation, while norms and expected behaviors connected struggling to perform in the context of to one position disagree with those decreasing funding. In an effort to address ascribed by another position held by the these growing pressures, secure funding, same individual (Biddle & Thomas, 1979; satisfy performance and outcome Broderick, 1998; Turner, 1996). When requirements, as well as improve the charged by the profession to deliver appearance of service utilization, human services to those in need (i.e., expectations services have developed strategies such as derived from the professional role) and misreporting, inflating statistics, faced with organizational policies that prolonging treatment of clients, multiple restrict service delivery (i.e. expectations counting and double booking of clients, related to employment affiliation), the selecting clients based on ability to pay potential for conflict is high. The conflict and potential for success, as well as may be exacerbated by the large and terminating clients who are unable to meet growing number of untreated populations, fees (Abramovitz, 2005; Arches 1991; such as the chronically mentally ill, Gallina, 2007; Kane, Hamlin, & Hawkins, uninsured, underinsured, and those 2003). struggling with substance-related issues Because of the increasing rigidity of (Amaro, 1999; Gibeaut, 2000; Meinert, eligibility criteria, decreasing resources Pardeck, & Kreuger, 2000). Furthermore, dictated by market “philosophy” embraced the aforementioned strategies used by by the organizations that restrict service agencies to alleviate the pressures may in delivery, and growing demands for themselves conflict with the professional spending time and energy on producing ethics, further intensifying workers’ role written reports, social workers’ conflict. professional obligations became hard to The resulting role conflict may lead achieve, and their ability to provide to workers’ mounting stress and frustration satisfactory direct service to all who need (Abramovitz, 2005, Collings & Murray, them has shrunk (Abramovitz, 2005; Brill, 1996). The stressful nature of social work 2001; Carpenter & Platt, 1997; Franklin, in general has been well documented 2001; Galambos, 1999; Gibelman & (Acker, 1999; Collings & Murray, 1996; Whiting, 1999; Mirabella & Wish, 2000; Gilbar, 1998; Himle, Jayaratne, &

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Thyness, 1993; Jayaratne & Chess, 1986; facing social workers can emerge to inform Lloyd, King, & Chenoweth, 2002; Tidd & strategies for resolving or ameliorating the Friedman, 2002; Um & Harrison, 1998). conflict and thus enhancing workers’ Specifically, sources of stress in the performance. current practice environment have been identified as administrative requirements, 2. Method planning and meeting performance targets, challenges in resource allocation, lack of 2.1 Sample autonomy, high turnover rates, the bureaucratic nature of the environment, The sample was comprised of 376 and, the amount of work, all of which may NASW members residing in a influence negatively on social workers’ demographically diverse suburban area in ability to deliver quality services to clients the Northeast, who responded to a mailed (Abramovitz, 2005; Acker, 1999; Collings survey (response rate was 17%). & Murray, 1996; Furman & Langer, 2006; Respondents were mostly white, middle Gummer, 1996; Himle, Jayaratne, & age, MSW level, experienced females who Thyness, 1993; Jayaratne & Chess, 1986; reported familiarity with the NASW Code Lloyd, King, & Chenowth, 2002; Um & of Ethics. About half were involved Harrison, 1998). While role conflict and exclusively in direct client services, a third role stress in social workers have been well combined client services and documented separately, their relationships administrative roles, and 13% were with being “trapped” has not been studied administrators. Seventy nine percent of the empirically; i.e., whether role conflict and participants identified their employment its subsequent stress are related to the settings, which included mental health disparity between the two sets of demands clinics (19.2%), medical settings (17.3%), that workers encounter due to their schools (7.4%), residential care (3.5%), professional commitment on one hand academia (2.1%), and the legal system and the organizational and administrative (1.3%). Twenty-seven percent were self nature of the setting in which they practice employed. Most practitioners worked in on the other hand remained to be either the nonprofit (41.5%) or for-profit examined. This question is the focus of the (38.6%) private sector and 18.4% worked current study. Specifically, it explored in the public sector. One and a half percent three questions relative to workers’ (1.5%) did not respond to this question. perception of practice situations that reflect typical issues of incompatibility between professional ethical principles and 2.2 Procedure administrative expectations regarding decisions about clients. First, are the Research packets were mailed to situations viewed as causing an ethical potential respondents. The packet included conflict; second, are they perceived as a letter of introduction, a description of the frequent; and finally, are they assessed as study, a demographic questionnaire, and inevitable in today’s professional the instrument Perceptions of Conflict in landscape. In addition, this study sought to Contemporary Practice Settings, as well as examine associations among these three a postage paid return envelope. The letter perceptions. By exploring these questions, of introduction and description of the study a better understanding of the challenges emphasized the voluntary nature of the study, identified inclusion criteria and

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve measures taken to protect participants’ respondents, n= 166), fewer than a quarter anonymity, specified the commitment of the participants reported occurrence of asked of participants, and described the situations described in the vignettes. potential benefits of the study. Returning The descending order of occurrence was: of the survey indicated proxy for consent. terminating clients based on inability to pay, misrepresenting information to meet 2.3 Measures performance/outcome requirements, selecting clients based on potential for success, inflating statistical data to satisfy Eight vignettes describing practice reporting requirements, prolonging situations that reflect the potential ethical treatment to satisfy utilization rates or issues identified above were developed on performance targets, misrepresenting the basis of the literature and personal information on grants proposals, and practice experience (Abramovitz, 2005; double booking clients to maintain fiscal Arches, 1991; Gallina, 2007; Kane, viability (23.6%, 17.2%, 14.6%, 13.2%, Hamlin, & Hawkins 2003). Participants 13.2%, 11.2%, 9.0% respectively). were asked to rate on a 6-point Likert scale Although the situations described (ranging from 0 for strongly agree to 5 for in the vignettes were reported to occur strongly disagree) the frequency in which with limited frequency, respondents each of the eight situations occurs in their viewed encountering all of them as practice, the degree to which they view creating an ethical conflict for each practice situation as presenting a practitioners. Viewed as causing such a value conflict, and, the extent to which conflict by the largest number of they find each practice situation to be participants were situations that required inevitable in social work practice. For them to provide false information relative example, a sample item read: Please read to performance and outcomes or carefully the following vignette describing information on grants to obtain funding, a practice situation and address the along with inflated statistics to satisfy questions following it. Terminating clients reporting requirements (79.3%, n=264; based on their inability to pay. Examples: 78.8%, n=252; 78.4%, n=247, Termination of a client because insurance respectively). About three quarters of the benefits are running out or because client participants viewed as causing an ethical can no longer meet established fee. Please conflict situations that involved direct indicate 1) the frequency within your impact on clients such as prolonging practice setting that social workers are treatment to satisfy utilization rates or faced with the above situation; 2) to what performance targets and terminating clients extent you find the above situation to be a based on inability to pay (76.1%, n=268; value conflict; 3) to what extent you find 75.7%, n=274 respectively). Selecting the above situation a necessary part of clients with greatest potential for success contemporary practice. was viewed as causing an ethical conflict by 73.1% (n=245), double booking by 3. Results 71.7% (n=246) and selecting clients based on ability to pay by 67.7% (n=245). The findings indicated that with the Participants’ view of the situations exception of selecting clients based on described in the vignettes as inevitable their ability to pay (reported by 44.6% of varied. Financially-related situations, such

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve as selecting clients based on their ability to based on ability to pay as being frequent pay and terminating those who could not did not judge it to be a conflict (.103 pay, were seen as inevitable by the largest p<.005 n=362). Thus, respondents who number of respondents (67.7% n=245 and saw terminating clients based on inability 61.5% n=255 respectively), followed by to pay as causing a conflict also saw it as misrepresenting reporting information to inevitable, and those who perceived meet performance or outcome selecting clients based on ability to pay as requirements, selecting clients based on being frequent did not judge it to be a their potential for success, inflating conflict. statistical data to satisfy reporting requirements, prolonging treatment to 4. Discussion satisfy utilization rates or performance targets, misinformation on grant Because the sample in this study documents, and double booking (32.9%, was self selected, the generalizability of n=109; 30.7%, n=103; 28.4%, n= 90; the results is limited. Furthermore, data 25.4%, n=89; 29.2, n=94; 24.3%, n=84 was collected by means of a self respectively). administered questionnaire, and A correlation analysis indicated a respondents did not have an opportunity to significant positive association between ask questions for clarification. Therefore, participants’ report about the frequency of responses depend on their interpretation of all eight practice situations and the degree the practice situations. Also, this to which they viewed such occurrence as instrument has been newly devised and inevitable in contemporary social work was first used in the described study; thus, practice; that is, those who reported its psychometric characteristics have been common occurrence of a practice situation established only to a limited degree. also viewed it as inevitable. This In spite of these limitations, the correlation was highest for misrepresenting study can offer some insight into ethical performance or outcome information, issues that social workers may face and followed by selecting clients based on their potential implications for practice and success prospects, misrepresenting grant future research. The combination of high information, selecting clients based on rates of reported inevitability and ability to pay, inflating statistical data, perceived value conflict confirms that double booking, prolonging treatment, and social workers indeed experience being terminating clients based on inability to caught between their professional pay (.624, n=330; .492 n=334; .49,1n=321; commitment and the market forces that 470, n=362; .433, n=314; 420, n=344; . guide their practice environment. Nowhere 403, n=350; .20,8n=365 respectively; p≤ . was being caught between a rock and a 01). hard place more evident than in the finding However, the view of a situation as that inevitability of terminating clients causing an ethical conflict was based on inability to pay and perceived significantly correlated with its perceived value conflict were significantly negatively inevitability only relative to terminating correlated, reflecting respondents’ belief clients based on inability to pay (r=-.150 that this practice, as well as other fiscally p<.001 n=360; r is negative because of driven practices, breaches the mission of scoring direction) and with its reported the profession and their feeling forced to frequency only relative to selecting clients follow it.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve That participants reported most of environment in which they practice and the situations, which they saw as both their inability to escape compromising causing ethical conflict and inevitable at their ethical values. least to some degree, as occurring To avoid such a painful infrequently may raise the possibility of acknowledgement, participants need to under-reporting to avoid a cognitive reconcile their perceptions of the realities dissonance, i.e., the discomfort of the professional environment with their experienced as a result of having views of themselves as ethical. To achieve conflicting attitudes, beliefs, or behaviors this goal, they could either change their simultaneously (Festinger, 1957). Because evaluation of the situations or minimize the people strive to maintain harmony among occurrence of the situations. The former their attitudes, beliefs, and behaviors, when route would expose them to the danger of inconsistency (i.e., dissonance) occurs, an providing socially undesirable responses. effort to change one of them is made. Because the situations clearly violate Being forced to act against their own ethical values, participants will have to beliefs may create such a dissonance admit that they compromise these values (Festinger & Carlsmith, 1959). To address and thus the integrity of their professional the discomfort brought on by dissonance, identity as practitioners in a value-based three strategies may be used: the behavior profession may be threatened. However, if may be changed, the perception of the they minimize the occurrence of the importance of the cognition re-evaluated situations, the discrepancy between their and altered, or a new cognition may be perception of themselves as professionals added (Bacharach, Bamberger, & and of their practice reality is decreased, Sonnenstuhl, 1996, Greenwald et al., 2002, protecting them from conflict and guilt. Greenwald, McGhee & Schwartz, 1998, The findings of this study agree Watson & Winkelman, 2005). with Abramovitz’ (2005) findings relative It is conceivable that practitioners to the negative effects on workers of a who experience a conflict between practice environment that is perceived as professional values and job tasks and feel unethical, such as the restrictive eligibility forced to practice in a way that is not criteria and access to welfare, as well as consistent with their ethical values and high demands for outcomes and professional identity experience a performance assessment. Abramovitz dissonance (Taylor, 2007) and struggle to documented reports by practitioners of reduce the resulting discomfort. Because deliberate misreporting, as well as respondents perceive situations of the type concealing client information from funding described in the vignettes as causing sources in an effort to preserve services to ethical conflict, if they saw these situations clients. At this juncture, the literature as frequent, they would have to face a portrays individual workers grappling reality of practicing in an unethical alone and making decisions unilaterally professional environment, thus causing (Abramovitz, 2005). However, in the field, dissonance. At the same time, because they human service agencies have begun view the situations as inevitable, i.e. they collaborating in the difficult task of feel pressured to act as the practice lobbying for change, because advocating situations suggest, admitting their for change sometimes may become “biting frequency would force respondents to face the hand that feeds you.” However, as the their own powerlessness to change the experience of other helping professions

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve such as nursing suggest, a promising route Bacharach, S. B., Bamberger, P., & to resolving professional dissonance is Sonnenstuhl, W. J. (1996). The raising awareness, creating coalitions, and organizational transformation process: advocacy for the client and the profession. The micropolitics of dissonance reduction Such efforts should be augmented by and the alignment of logics of action. research relative to fiscal and market Administrative Science Quarterly, 41, (3) pressures and their manifestation in 477-506. practice to equip the profession with better understanding of the processes as well as Beresford, P. (2005). Redistributing profit guidelines for developing strategies to and loss: the new economics of the market effectively address them. The combination and social welfare. Critical Social Policy, between organization of the professional 25, (4) 464-483. community and developing more knowledge has the potential of developing Biddle, B. J., & Thomas, E. J. (Eds.). an environment that allows professionals (1979). Role theory: Concepts and to perform ethically while considering research. Huntington: Robert E. Krieger relevant market forces. Publishing Company.

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Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Social Work, Morally Relevant Properties, and Paternalism: Why Social Workers Need to Know Moral Theory

Caroline E. Reid, MSW Eastern Kentucky University [email protected]

C. Kamper Floyd, MA University of Southern Mississippi

Valerie Bryan, PhD University of South Alabama

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of White Hat Communications.

Abstract promote ethical reasoning due to their This paper speaks to the inherent structure as basically non- complexity of the social work practice malignancy statements prohibiting certain environment that requires social workers to actions. However, the complexity of the know moral theory. The authors present a practice environment inevitably means that rationale for social workers using moral codes alone cannot guide all or even most theory and demonstrate how this can of daily social worker actions with their inform ethical reasoning in the context of clients. In addition, the code does not case decision-making. establish a hierarchy of ethical principles leaving the practitioner with unanswered Key Words: Social Work Code, Ethics, questions such as how one solves a Moral Theory, Paternalism problem when principles collide. For example, the principles of promoting a 1. Introduction client’s well-being and promoting a Although social work has a Code of client’s autonomy often come into conflict. Ethics (NASW, 2006) and each state has What is needed is a template for ethical codes based on the national code, it reasoning that, while being perhaps remains a question as to how codes of reconcilable to formal and deontological ethics can lead to ethical reasoning among codes, arms social workers to deal with the social workers in practice settings. It infinite variation in case scenarios and would appear that ethical codes can challenges and that provides a way to constrain unethical actions, but they cannot navigate between key ethical principles in

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve specific case instances. This paper will knowledge base and theory upon which present a rationale for social workers using they can make decisions, especially ethical moral theory and will also demonstrate decisions. how this can inform ethical reasoning in The current NASW Code of Ethics the context of case decision-making. (2006) is built on principlism. The most Gert, Culver, and Clouser (2006) widely accepted formulation of believe that in professions, codes of ethics principlism, put forth by Beauchamp and serve as a collective recognition by Childress (2001), includes the following: members of a profession’s responsibilities; respect for autonomy (respect for people’s it can help create an environment in which values and decisions); beneficence ethical behavior is the norm; it can serve as (helping others); nonmaleficence (not a guide or reminder in specific situations; harming others); and justice (treating all can serve as an educational tool, providing cases alike; distributing benefits and harms a focal point for discussion in classes and fairly). The four principles are considered professional meetings; and finally, a code role-specific duties and are prima facie can indicate to others that the profession is (duties considered always to be in effect). seriously concerned with responsible, The NASW Code of Ethics acknowledges professional conduct. Gert, Culver, and that it does not “specify which values, Clouser (2006) maintain that the primary principles, and standards are most purpose(s) of a professional code of ethics important and ought to outweigh others in is to help educate and socialize new instances when they are in conflict” (p. 3) members into the profession, as well as but at the same time it indicates that one of current members of the profession. It its purposes is to “help social workers should be of practical use. A Code of identify relevant considerations when Ethics should tell individuals how they professional obligations conflict...” (p. 2). ought to act. A Code of Ethics should rest The Code indicates that values and on a public moral system that includes standards should be rank ordered when rules and ideals. conflicts arise, but does not specify how to Social work’s Code of Ethics, rank order. although informed by contemporary principlism, is based upon the professional 2. A Brief History of Social Work purpose and mission of social work, and as Ethics social work’s focus and emphases have Literature identifying and changed over time, so has the Code. The specifying the relationship between social current Code of Ethics (2006) indicates work’s core ethical values and practice has that the social work profession is “rooted existed almost as long as the profession in a set of core values--service, social itself, although its focus has noticeably justice, dignity and worth of the person, shifted over time. At the midpoint of the importance of human relationships, last century, keen interest in what social integrity and competence” (p. 1). Because work’s guiding values should be began to social work is a moral activity requiring emerge. The first major work pertaining to social workers to make and implement social work ethics published in 1959, The difficult decisions about human situations Teaching of Social Work Values and that involve the potential for harm and Ethics by Muriel Pumphrey, identified good, social workers should have a solid

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve professional, societal, and cultural values emerge from issues including but not as the desired focal point of ethics limited to client autonomy and paternalism education (Reamer, 1998, as cited in (Abramson, 1985; Albers & Albert, 1998), Bryan, 2006). This era is often identified duty to protect versus client confidentiality as the origin of serious scholarly interest in (Dickson, 1998), and informed consent social work’s ethical foundation (Reamer, within coercive settings (Regehr & Antle, 1994, 1998; Haynes, 1999). When the 1997). In a compilation of historical and political upheaval of the 1960s shifted empirical social work ethics literature, national focus to civil rights and social Reamer (1994) specifies the values justice issues, the social work ethics conflicts that may emerge from efforts to literature from this era also reflected this accommodate social work’s core values: renewed emphasis. In 1960, the National personal versus professional values, values Association of Social Workers (NASW) and beliefs of the worker related to the adopted its first Code of Ethics. Efforts to nature of clients’ problems, and disputes identify what social work’s core values over the relative importance of the were and to unite the profession around profession’s values. these principles continued on throughout The question of how one might the 1960s and 1970s (Reamer, 1998). address these conflicts of principles has Contemporary Social Work Ethics directed the development of decision- Literature. making models and social work ethics The most recent version of curricula within recent years (c.f. NASW’s Code of Ethics (2006) continues Congress, 2000; Fleck-Henderson, 1991; to reflect the principlist emphasis Haynes, 1999; Pine, 1987). All share a contained within earlier versions, with its common strategy of asking a series of focus upon the profession’s values base. It questions grounded in an exploration of lists the previously identified six “core principles that pertain to moral conflicts values” and states that these provide “the and applying these investigative questions foundation of social work’s unique to ethical problems. However, no two purpose and perspective” (NASW, 2006, p. decision models ask exactly the same 1). questions, whereas all require individual Social work ethics literature within interpretation without any form of public recent decades discusses the application of justification, which may lead to these core values across a wide range of inconsistent, capricious decision making practice domains and topical issues, (Bryan, 2006). All similarly lack a varying from social workers’ personal theoretical foundation. perspectives on human nature and their With the shift in attention from resultant effects upon practice (Goldstein, values exploration that emerged in the 1989; Reamer, 1983) to the identification 1950s to moral conflict resolution and of values conflicts as encountered across strategies to accomplish this in recent various client settings (Abramson, 1985; years, it is necessary for social work to Gray, 1996; Albers & Albert, 1998; Dean more carefully evaluate the process & Rhodes, 1998). Social work ethics through which ethical conflicts should be scholars have tended to emphasize and resolved. Though inconsistent, decision explore the difficulties in managing models do tend to elicit the underlying conflicts between ethical principles as they moral quandary preventing a simple

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve outcome. However, it must be noted that is found in Mill’s On Liberty (1978). the capability to identify a conflict in Other, more recent classic articles include values does not necessarily make Dworkin’s (1973) Paternalism, Carter’s resolution of the conflict any easier. No (1977) Justifying Paternalism, and matter how explicit the identification of Buchanan’s (1978) Medical Paternalism. conflicting values may be, one may be no These works discuss paternalism in more prepared to decide what to do than if relation to the government and individual the conflict had not been clarified in the liberty or in the medical context, where first place. Something beyond the use of paternalism is pervasive. Although these atheoretical decision-making models or are classic works on paternalism, none of “decision trees” is clearly needed. them ties paternalism to social work. Reamer (1983) discusses paternalism in 3. The Need for Moral Theory: the context of social work. In this The Example of Paternalism foundational work, he clearly understands Social workers need to know moral the importance of the topic to social theory in order to make the best ethical workers and makes some of the same kinds decisions with regard to clients. Social of points that are made in the following workers are at risk for making poor paragraphs regarding paternalism and decisions, especially when it comes to client self-determination. He also offers a behaving paternalistically toward their brief history of some of the classic works clients. This paper relies on the work of mentioned above. However, Reamer Gert and Culver (1979), which provides a manages to discuss paternalism in social systematic and useful way to deal with the work without ever explicitly mentioning problem of paternalism in social work. The moral theory. This is a gap that the present authors assert that sometimes paternalism article bridges. This article ties can be justified and sometimes it cannot be paternalism to social work and does so in a justified. For acts of paternalism to be way that highlights the importance of justified, the authors assert that there must moral theory for social work practice. It is be a procedure of justification. important to remember that the main point Consequentialism, deontology, casuistry, of this article is one about the need for the theory of virtue, situation ethics, and social workers to have an understanding of principlism do not aid in helping to moral theory. The example of paternalism distinguish between cases of justified and is intended to facilitate an understanding of unjustified paternalism. Using the this main point, and, given the example of paternalism, this paper will complexities of social work practice, explicate the key concepts of Gert, paternalism is a natural choice. Clouser, and Culver’s (1997) common Consequently, a discussion of the history morality framework by applying his of paternalism is limited to these remarks. analytic steps and justification procedure Paternalism is, in simplistic terms, to the case of paternalistic actions. acting on another’s behalf without his or Given the many people who have her explicit consent. A more scholarly written about paternalism, one might definition is given by Abramson (1985): wonder why more needs to be said about “Paternalism is a form of beneficence in the topic. The classic work on paternalism which the helping person’s concepts of benefits and harms differ from those of the

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve client, and the helper’s concepts prevail” and she must do so without undermining (p. 389). It arises out of a wish to help the client’s progress toward self- others and can be beneficial to clients in determination. As a result, the social certain cases, particularly when clients worker is always in danger of making have limited decision-making capacity. decisions on behalf of the client’s well- However, paternalistic actions undermine being. The social worker is in danger of the value of self-determination and limit acting paternalistically if she does not autonomy by taking away clients’ rights to make and carry out these decisions with make their own decisions. Because due care. paternalism limits freedom, this suggests a Paternalism is an inherent need for the ability to determine in which component of social work. Social workers’ cases paternalistic decisions should or duties to others, including protecting should not be made. rights, intervening in high risk situations, providing court-mandated services or Paternalism and Social Work: Clarifying assistance to involuntary clients, and the Problem providing (or not providing) information Why might one think that social during the consent process and in other workers are in danger of acting client contacts all involve evaluating paternalistically in the first place? After decisions about potentially paternalistic all, if social workers rarely act acts (Reamer, 1993, as cited in Kaplan & paternalistically, the claim that social Bryan, 2009). Simultaneously, social workers need to know moral theory to workers are mandated to respect individual avoid acting paternalistically is not self-determination and to enhance societal compelling. To assert the claim that social well-being, which may conflict in practice. workers are frequently in danger of acting Albers and Albert (1998) identify the very paternalistically, one need only consider purpose of social work as embedded within the aim of social work and the nature of the conflict between the needs of the self paternalistic behavior. Since social and those of society. In many cases, workers care about helping others, it is agency policies may indicate that the social important that they not impede their clients worker should act paternalistically, in becoming autonomous. To do so would whereas the Code of Ethics would suggest undermine the very value of their efforts. the opposite. Conflicts between social However, it is difficult to discern when the workers and clients commonly occur when social worker’s assistance is helpful and they disagree about whether or not when it serves as an obstacle for client workers’ paternalistic actions are self-determination. This is due to several beneficial to clients from the clients’ factors, including the power differential perspective (Abramson, 1985, as cited in inherent in the social worker/client Kaplan & Bryan, 2009). These kinds of relationship, the context of the working decisions call for justification of the relationship, namely, the kinds of issues professional’s actions (Kaplan & Bryan, that led to the formation of the 2009). relationship, and the vulnerability of the Two distinctions regarding the clients. These, of course, are interrelated meaning of paternalism are relevant here. issues. The social worker is placed in the The first distinction is between position of helping a client better her life, paternalistic acts and acts that seem

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve paternalistic but really are not. For We will now turn to Gert, Clouser, example, a mother’s actions toward her and Culver’s (1997) concept of the very young children might count as common moral system (also known as paternalistic. After all, mothers often act common morality) and explore its key on behalf of their children without their features of rules, morally relevant features, explicit consent. However, to view this as rules violations, and justification. It will be paternalism is clearly absurd. Restricting a shown here that paternalistic acts are like two-year old’s freedom for the sake of his other rules violations in that they require or her own good is a parental, not justification to be morally acceptable. In paternalistic, action. This is just what doing so, we will define paternalism in parents are supposed to do in order to raise such a way that allows distinguishing their children. Suggesting that these kinds between morally prohibited and morally of parental acts are paternalistic misses the permissible paternalistic acts. point of what it means to be a parent. The second distinction is between justified acts 4. Moral Justification, Morally of paternalism and unjustified acts. A Relevant Features, and Moral justifiable act of paternalism is one in Theories which an act counts as paternalistic, but it Moral Rules and Rules Violations. is one most rational persons would excuse. According to Gert, Clouser, & An unjustifiable paternalistic act is one that Culver (1997), morality is an informal most rational persons would not excuse, public system. All informal public thereby holding the agent as morally systems share two features: (a) all those to culpable for causing a person harm. whom the system applies understand it, If all acts of paternalism are and (b) it is rational to submit oneself to unjustified, then it is likely that social the system. They define rationality in workers commit many acts of unjustified terms of irrationality: “to act irrationally is paternalism. This conclusion, if sound, to act in a way that one knows, or should would severely undermine the social utility know, will significantly increase the of the social work profession. It amounts probability that oneself, or those one cares to the claim that the social work profession for, will suffer death, pain disability, loss is based on practices that ultimately of freedom or loss of pleasure; and one perpetuate immorality. The social does not have an adequate reason for so usefulness of the social work profession is acting” (p. 26). Their system of morality is evident in the lives of the many people an explicit formulation of what they take to who have been helped by social workers. be implicit in the way most people deal Unless social workers want to embrace the with everyday moral issues. They submit idea that acting immorally is a good way to ten moral rules that reflect the emphasis on go about helping others, then some acts of harm that is evident in their definition of paternalism are justified. If social workers irrationality: do not kill, do not cause pain, cannot properly justify any acts of do not disable, do not deprive of freedom, paternalism, they place their clients in do not deprive of pleasure, do not deceive, harm’s way. The NASW Code of Ethics keep your promise, do not cheat, obey the (2006) speaks to paternalism in Section law, do your duty (Gert, Culver, & 1.07b. Clouser, 2006). According to these

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve authors’ concept of common morality, Gert, Clouser, & Culver (1997) moral rules are not absolute, but justified also make it clear that sometimes there are violations of those rules must be impartial situations in which there will be and must be public (in the sense that all disagreement about rules violations, even rational persons would allow such when the circumstances are the same. In violations if they were in a similar every case of a potential rules violation, situation). the social worker must first determine the The rules provide the foundation of morally relevant features and then consider the common morality framework. Gert, the consequences should everyone know Clouser, and Culver (1997) note that these that it is permissible to violate rules under are general, universal rules that are made the same circumstances to justify his or her specific by context. For example, a specific position. Gert (1998) presents a series of case of violating “Do not cause pain” may questions as a guideline designed to elicit involve spanking a misbehaving child, important facts about a moral issue making cruel comments to a friend, or (morally relevant features), which the assisting a patient with physical social worker should ask when considering rehabilitation exercises. He reasons that a violation of a moral rule rational persons agree to abide by the 1. What moral rule is being violated? moral rules so that they avoid having these 2. What harms are being caused by the harms committed against them. Although it violation? What harms are being is asserted that all are equally important, avoided by violating the rule? What the second five rules tend to increase the harms are being prevented by the likelihood that one of the first five rules violation? will be broken. For instance, deceiving a 3. What are the relevant desires and client (rule 6) by not providing all beliefs of the person toward whom the information about her choices during the rule is being violated? informed consent process increases the 4. Is the relationship between the person likelihood that her freedom to make an violating the rule and the persons informed decision will be impaired (rule toward whom the rule is being violated 4). such that the former has a duty to violate moral rules with regard to the Morally Relevant Features latter independent of their consent? 5. What goods are being promoted by the Because the rules are general, they violation? require interpretation to be applicable in 6. Is the rule being violated toward a particular cases. It is possible for people to person in order to prevent her from disagree about how to correctly apply the violating a moral rule when the rules in particular cases. Consequently, violation would be unjustified or weakly what may at first seem like a gross justified? violation of a moral rule may actually be 7. Is the rule being violated toward a morally permissible. Because paternalistic person because he has violated a moral acts involve, by definition, the breaking of rule unjustifiably or with a weak a moral rule, all acts of paternalism require justification? justification. 8. Are there any alternative actions or policies that would be preferable?

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve 9. Is the violation being done intentionallyPaternalism as a Moral Rules Violation or only knowingly? Returning to the previous 10. Is the situation an emergency such discussionthat regarding paternalism, it should no person is likely to plan to be in thatbe clear that paternalistic acts in some kind of situation? cases are justified violations of moral rules, and in others, are unjustified. (Gert, 1999 pp. 17-19). However, the definition of paternalism must be made explicit to assist the social Not all of the questions apply to worker with analysis of the situation. Gert every case. Some questions are more & Culver (1979) define paternalistic important in some contexts than others. behavior in the following way: There may be, Gert (1998) admits, many A is acting paternalistically toward morally relevant properties that the S if and only if A’s behavior questions do not help highlight. It is these (correctly) indicates that A believes kinds of considerations that make the that— questions “guidelines.” The answers to the questions are the morally relevant (1) his action is for S’s good; properties one should consider in deciding (2) he is qualified to act on S’s whether a particular act is morally behalf; permissible. (3) his action involves violating a moral rule (or will require him to Justification of Rules Violations. do so) with regard to S; (4) S’s good justifies him in acting The analysis hinges upon an on S’s behalf independently of S’s important process of justification, arguably past, present, or immediately the most useful feature of the common forthcoming (free, informed) moral system of decision-making. Gert consent; and (1999) suggests two questions related to (5) S believes (perhaps falsely) that the deontological concept of the he (S) generally knows what is for categorical imperative in order to evaluate his own good (p.196). if violating the rules is justified in a case: 1) Could anyone in these kinds of One’s actions are paternalistic, circumstances violate these rules? and 2) then, if they are motivated by certain kinds Would it still be allowed if everyone knew of beliefs. For example, suppose an adult that these rules could be violated in these client admits he intends to harm himself circumstances? These questions answer physically but has no desire for his social whether or not rules violations in particular worker’s assistance in helping him work circumstances are impartially and publicly through this issue. The social worker allowed. This analysis requires the decides that the client should be placed practitioner to consider whether the long- under suicide watch, and the social worker term consequences of violating rules do does what is needed to have him more harm than not violating rules in hospitalized. (This is a simplified version particular situations (Bryan, 2006). of a case that Gert, Clouser, & Culver, 1997, formulate.) The social worker’s action is motivated by the following

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve beliefs: The client is better off alive than paternalistic acts toward their clients, they he is dead (condition 1); the social must know moral theory. worker’s training provides them with the This section explains the difference necessary skills and knowledge to act on between justified and unjustified the client’s behalf (condition 2); the social paternalistic acts and demonstrates how worker believes that hospitalizing the social workers can avoid acting in an client restricts his freedom and/or could unjustifiably paternalistic toward their cause her some other kind of harm clients. Such avoidance depends on social (condition 3); the social worker does not workers knowing moral theory. First, an think that she needs the client’s permission explanation of the different kinds of to have him hospitalized (condition 4); and paternalism is in order. the social worker believes that, as a To identify cases of justified rational adult, the client generally knows paternalism, one must be able to identify what is in his best interest (condition 5). which acts are morally permissible. A Considering all of the beliefs that motivate morally permissible act is one that a person the social worker’s behavior, the social is allowed to do but not required to do, as worker’s choice to involuntarily stated by some moral theory. Contrast a hospitalize her client is a paternalistic one, morally permissible act with an act that is as defined by Gert and Culver. To be sure, either morally required or morally the social worker’s behavior might be forbidden. A morally required act is an act excusable. Whether or not it is excusable that one is obligated to do. A morally is discussed below. forbidden act is an act that is always wrong A violation of a moral rule to perform. involves, according to Gert, Clouser, and Exactly which acts are deemed Culver (1997), causing harm such as death, morally required or forbidden depends on pain, disability, loss of freedom, the moral theory under consideration. For opportunity, or pleasure. In acting without example, utilitarians think that the moral obtaining the consent of her client, a social value of an act is derived from the act’s worker is violating a moral rule — consequences. Deontologists think that the depriving her client of freedom (Gert & moral value of an act depends on the Culver, 1979. p. 51). So, in fulfilling intention with which a person performs the condition 4, one is causing harm, thus act. Given their different assessments of fulfilling condition 3. what gives moral value to an act, it is clear As stated, some paternalistic acts that utilitarians and deontologists will are justifiable and others are not. What is differ on their lists of morally required and important to recognize is that all cases of morally forbidden acts. These are just two paternalism, by their very nature, violate examples. Other moral theorists, ones who the moral rules, by depriving clients of are not deontologists or utilitarians, would their right to freely make their own say that moral value is derived ultimately choices. Often, other rules are also from something other than consequences violated. Therefore, all potential acts of or intentions. paternalism should be analyzed as to their Whatever the case, given a moral moral permissibility. If social workers theory, most people would agree on which wish to avoid committing unjustifiable acts are morally forbidden and morally required, and they would likely agree that

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve many acts do not fall into either category. a strong justification. Acts of paternalism Justified acts of paternalism are morally that are strongly justified would count as permissible. No acts of paternalism are morally permissible acts. This amounts to ever morally required. Claiming that some the claim that all people would agree that acts of paternalism are justified means that universally allowing the act of paternalism some acts of paternalism are not morally in certain circumstances would prevent forbidden. For these acts, compelling more harm than it would cause. When reasons are needed to convince others that there is a disagreement about the rational the acts are morally permissible. Offering acceptability of the justification, the reasons in these kinds of cases amounts to justification counts as weak. Acts of giving a justification for the moral paternalism that are weakly justified are permissibility of some acts of paternalism. acts that might be morally permissible, but What counts as a justification for a there may be consequences for doing them. paternalistic act? Gert and Culver (1979) As noted earlier, the justification of a claim that any justification of a paternalistic act should have two features: paternalistic act must have the following (1) it would be irrational for the person necessary features: (1) a description of the against whom the act of paternalism is benefit that would be gained by the person committed not to agree to the act, given the to whom the paternalistic act is directed chance and (2) all rational persons would and (2) the harms prevented by the agree that if they were in a similar paternalistic act need to be “much greater” situation, paternalism would be acceptable. than the harm of committing the act. For a Consider the qualifications in turn. justification to count as sufficient, it must If qualification 1 were false, then it would say how the paternalistic act would be be rational for persons to act in such a way acceptable to all rational persons in similar as to “significantly increase the probability circumstances. So, a justification of that oneself, or those one cares for, will paternalism must show that (1) it would be suffer death, pain disability, loss of irrational for the person against whom the freedom or loss of pleasure; and one does act of paternalism is committed not to not have an adequate reason for so acting.” agree to the act, given the chance and (2) Clearly this defies logic. Consider all rational persons would agree that if they qualification 2. According to Gert, were in a similar situation paternalism Clouser, & Culver (1997), specifying the would be acceptable. circumstances is a matter of specifying the Whether or not an act of kinds of paternalistic acts one could paternalism is justified depends on the publicly advocate. To say that an act is quality of the justification given for the act. one that could be publicly advocated is to There are different kinds of moral say that it could be explicitly incorporated justification (Gert, Clouser, & Culver, into the informal, public system of 1997). The reasons that one gives for morality without undermining the system. breaking a moral rule could be accepted by Kant’s example of the person who lies to almost everyone, or there could be obtain a loan illustrates Gert and Culver’s disagreement about whether one should point (Gregor, 1996). If one were to accept the justification. According to Gert publicly advocate the moral permissibility and Culver (1979), if the justification is of lying in order to obtain a loan, the accepted by all rational people, it counts as informal public practice of lending money

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve would be undermined. It would be philosophical work that these explanations undermined because the lenders would not do is just what theories are supposed to do. have the assurance that debtors would pay Theories are just explanations that back the loans. So, they would cease systematically tie together various lending money. Publicly advocating the phenomena in a certain domain. moral permissibility of an act that is Because one needs some sort of inconsistent with the informal public method for deciding which features of the system of morality would weaken the situations are similar, the question arises: system’s social efficacy. can one choose a method for deciding on The forgoing remarks might such features that does not presuppose indicate why specifying the circumstances some kind of moral theory? If this is a is important, but it says little about how possibility, then it would count against our one is supposed to figure out what main claim that it would be possible to situations count as similar, as stated in avoid acting in an unjustifiably qualification 2. How does one figure out paternalistic manner without knowing which situations are similar? To figure out moral theory. Perhaps one might want to the similarities in two different cases, one advocate using intuitions to figure out the needs a way to sift through all the features matter. Even granting that this kind of of both cases, picking out and comparing method does not presuppose some kind of the salient features of each case. Why is moral theory, there are obvious problems such a method needed? The reason is with this method. Different people have simple. Suppose it is possible to list different intuitions in different cases. So, everything—every action, thought, there would be no way to justify any act of background information, for example— paternalism. Why? Recall that to justify that constitutes the context of each case. It an act of paternalism, reasons must be is reasonable to suppose the lists would be marshaled that would persuade others. If too long to practically compare one with people do not share the same ethical the other. Even if it were not practically intuitions, people needing to be convinced impossible, given the complexity of will not respond to arguments based upon language, there are infinitely many ways to unshared intuitions. But, there is good describe each case. Without a method to reason to think that some acts of pick out certain features of each case, there paternalism are justified. So, using would be no possible way to (1) decide intuitions to decide the similarity of which descriptions should be compared different cases does not work. and (2) decide which features of those lists Because the justification of would count as comparable features. Any paternalism is a moral matter, the relevant, method that could be used for sifting comparable features of each case are moral through the various aspects of a situation properties. Gert (1999) defines the and picking out the relevant features of morally relevant properties in the each case would need to give an following manner: “A morally relevant explanation of (a) why it picks certain feature of a moral rule violation is a feature features over others, (b) why these features that if changed could change whether some are relevant, and (c) how (a) and (b) relate impartial rational person would publicly to paternalism. Otherwise, there would be allow that violation” (p. 16). If intuitions no way to choose a method. The can’t be used, then one must rely on

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve something else. Whatever method one Whereas knowing at least one adopts, it must be conceptually related to moral theory is sufficient for the argument the moral properties under consideration. presented above, it is better, at least from a This restriction automatically discounts practical standpoint, if social workers pure descriptive methods. A pure know many moral theories. Again, descriptive method is value free. To use a different moral theories accord different pure descriptive method to explain which moral value to particular acts. It stands to moral properties one should consider reason that different moral theories also salient would be violating the “is/ought” consider as morally relevant different distinction. Many people think that this features of similar situations. For example, fallacy is a genuine logical fallacy that because utilitarians are ultimately should be avoided; deriving an “ought” concerned with the consequences of an act, statement from premises that only contain they will place little or no value on the “is” statements confuses the difference intentions of the person acting, except between description and prescription. insofar as those intentions actually bring But suppose a descriptive method about certain consequences. Because is not completely value free. A descriptive deontologists ultimately care about a method that is not value free and explains person’s intentions for acting, they will the relevant moral properties is a kind of place little importance on the actual normative theory. A normative theory is consequences of the act. Other moral one that explains the action-guiding nature theorists will determine what counts as of values. All moral theories are morally relevant according to the theories normative ones, but not all normative they prefer. So, each kind of moral theories are moral ones. For example, a theorist is ultimately concerned with theory that explains etiquette is a different aspects of any particular case. normative theory that is not a moral one, Consequently, there is no common ground because matters of etiquette are not matters from which to decide which description of of moral significance. Because a case is to be utilized. If a social worker, paternalism is a moral issue, any normative then, wants to justify an act of paternalism, theory that explains paternalism would she needs to know enough about moral have to be a moral theory. So, we have the theories to offer reasons to someone who following results. Either a theory explains may adopt a different moral perspective what counts as similarities, or intuitions than she has. do, and we have established that intuitions To make the application of cannot. A theory is either purely paternalism, reconsider the case outlined in descriptive or it is normative. A purely the first section of this paper. Recall the descriptive theory cannot do the work. So, case: suppose an adult client admits he a normative theory must do the work. A intends to harm himself physically but has normative theory that is sufficiently strong no desire for the social worker’s counsel in to explain paternalism is a moral theory. helping him/her work through this issue. So, deciding the similarities of different The social worker decides that the client cases means utilizing a moral theory. Of should be placed under suicide watch, and course, one cannot utilize a moral theory if the social worker does what is needed to one does not know moral theories. have him hospitalized. The social worker’s action is motivated by the

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve following beliefs: the social worker properties of the case are and determining believes that the client is better off alive whether one would publicly allow this kind than he is dead; the social worker believes of violation. As argued, determining the that his/her training as a social worker morally relevant properties of a case provides him/her with the necessary skills depend on knowing moral theory. Using and knowledge to act on the client’s the moral theory developed by Gert behalf; the social worker believes that (1999), one can figure out the morally hospitalizing the client restricts his relevant properties of the case. Again, freedom and/or could cause him some nothing hinges on this particular moral other kind of harm; the social worker does theory. One could use another moral not think that he/she needs the client’s theory to the same end. However, given permission to have him/her hospitalized; the general nature of their method of and the social worker believes that, as a highlighting morally relevant properties, it rational adult, the client generally knows is probably the case that their method is what is in his/her best interest. consistent with other moral theories. Considering all of the beliefs that motivate Obviously, the more information the social worker’s behavior, the act of about a case one knows, the easier it will having the client hospitalized is a be to answer the questions listed above. paternalistic one. But, is it an unjustifiably The case we are considering lacks much paternalistic act? information that one might want. Although this paper has only Nevertheless, one can see how the described the case in outline, satisfying questions help even in cases in which the Gert and Culver’s two conditions for information is lacking. Consider questions justification is easy to do. Considering the 1, 2, 4, and 5. Acts of paternalism, by first point, the greatest benefit that the definition, involve breaking the moral rule client receives from the act of paternalism against deceiving others. By acting is that he is prevented from ending his life paternalistically in this case, certain harms or significantly causing damage to it. are being prevented, such as significant Living a life, it is assumed, is better than physical damage, possibly leading to prematurely ending it. Living a life with death. The relationship between the social less significant physical damage is better worker and the client is such that the social than living a life with more significant worker has a duty to act in the manner she physical damage. One could disagree with does. The client will receive certain the first benefit and still agree with the benefits, as explained above, from her act second. The second benefit is a of paternalism. With more information, it sufficiently strong benefit that there is no would be possible to answer all ten of the need to list more benefits. Without a questions. From the answers given so far, reason that would outweigh the benefits there is enough information for deciding gained from not acting paternalistically in whether this kind of act would be publicly this case, the client is acting irrationally. advocated, that is, whether it would be Regarding the second point, to morally permissible. If all rational persons show that all rational persons would agree would agree that allowing paternalism in that if they were in a similar situation this kind of case is justified, then the act is paternalism would be acceptable, amounts morally permissible. If there is to showing what the morally relevant disagreement allowing paternalism in

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve similar circumstances, the act might be are taught moral theory as a part of every morally permissible. It is plausible, based class they take. The second model requires only on the information given above, that students to take a discrete class on moral the social worker’s act is most likely theory. There is some evidence that the morally permissible. Even if it is not, the second model helps social work students example makes clear how a social worker develop their moral reasoning skills better might go about justifying an act of than the first model. The research suggests paternalism based on her knowledge of that by making moral theory a part of moral theory. every class, it is eventually neglected (see Sanders, 2006). Social work educators, 5. Conclusion then, need to take more seriously the idea that requiring social work students to take The argument developed so far in a discrete ethics course is more useful for this paper may be summarized in the the moral burdens of social work practice following manner: than requiring them to learn moral theory (1) To avoid acting in a paternalistic through a process of diffusion. Whatever manner that is problematic in a case, social method schools choose to teach moral workers need to justify the acts of theory to social work students, they need to paternalism they commit. take ethical theory more seriously than it (2) To justify the acts of paternalism they appears they do. commit, social workers need to know the Another implication of the morally relevant features of the cases of argument is that social workers need to paternalism they commit. hone their moral reasoning skills as (3) To know the morally relevant professionals. It is not enough to take one properties of the cases of paternalism ethics course as an undergraduate social social workers commit, they need to know work major or as a graduate master’s moral theory. student. Incorporating moral theory into (4) To avoid unjustified paternalistic the continuing education programs that actions in a case, social workers need to professional social workers must complete know moral theory. would not only serve professionals well; If social workers are in danger of more importantly, it could prevent clients frequently committing unjustified from being unnecessarily harmed by their paternalistic acts toward their clients and social workers. If social workers are as the argument above is sound, the concerned with the well being of their implications for social work education are clients as they claim to be, taking the clear. The most obvious implication is education of ethics seriously is a moral that social work educators need to take imperative that social workers cannot seriously their charge to teach social afford to neglect. workers moral theory. Currently, most social work programs teach ethical theory References through one of two models. The first model is the diffused model. In this Abramson, M. (1985). The autonomy- model, social work students do not take a paternalism dilemma in social work course in moral theory. Rather, students practice.Social Casework: The Journal of

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Contemporary Social Work, September, Gert, B (1999). Morally relevant features. 387-393. Metaphilosophy, 30 (1/3),13-24. Albers, D., & Albert, R. (1998). Gert, B. (1998) Morality: It’s nature and Introduction to special edition. Journal of justification. New York, NY: Oxford Law and Social Work 8(1 and 2), 3-10. University Press. Beauchamp T.L., & Childress J.F. (2001) Principles of Biomedical Ethics. Oxford Gert, B., & Culver, C. (1976). Paternalistic University Press, Oxford. behavior. Philosophy and Public Affairs, 6, (1), 45-57. Bryan, V.L. (2006). Moving from professionally specific ideals to the Gert, B., & Culver, C. (1979). The common morality: Essential content in justification of paternalism. Ethics, 89, (2), social work ethics education. Journal of 199-210. Teaching in Social Work, 26(3/4), 1-17. Gert, B., Culver, C., & Clouser, K. (2006). Buchanan, A. (1978). Medical paternalism. Bioethics: A Systematic Approach (2nd Philosophy and Public Affairs, 7 (4), 370- ed.). New York: Oxford University Press. 390. Carter, R. (1977) Justifying paternalism. Gert, B., Clouser, K.D., & Culver, C. Canadian Journal of Philosophy, 7 (1), (1997). Bioethics: A return to 133-145. fundamentals. New York: Oxford University Press. Congress, E.P. (2000). What social workers should know about ethics: Goldstein, H. (1989). The neglected moral Understanding and resolving practice link in social work practice. Social Work, dilemmas. Advances in Social Work, 1(1), 32, 181-186. 1-25. Gray, M. (1996). Moral theory for social Dean, R., & Rhodes, M. (1998). Social work. Social Work/Maatskaplike Werk, constructionism and ethics: What makes a 32(4), retrieved from: “better” story? Families in Society: The http://www.und.ac.za/und/socialw/moral.ht Journal of Contemporary Human Services, ml 79(3), 254-263. Gregor, M. (1996). Immanuel Kant. (M. Dickson, D. (1998). The duty to protect: Gregor, Trans). In Kant’s Practical Limitations on confidential Philosophy: The Cambridge Edition of the communications to social workers. Journal works of Immanuel Kant. Cambridge: of Law and Social Work, 8(1 and 2), 41-62. Cambridge Press. Dworkin, G. (1973). Paternalism. The Monist, 56 (1), 64-84. Haynes, D. (1999). A theoretical integrative framework for teaching Fleck-Henderson, A. (1991). Moral professional social work values. Journal of reasoning in social work practice. Social Social Work Education, 35(1), 39-51. Service Review, 65, 185-202.

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Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Research with Vulnerable Groups: Collaboration as an Ethical Response

Catherine Sherlock, Lecturer National University of Ireland Galway

Dr. Clare Thynne Clinical Psychologist HSE Mid West Limerick Ireland

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of White Hat Communications.

Abstract become an unguided projectile bringing turbulence to the field, fostering personal This paper explores the journey of a traumas (for the researcher and the collaborative research project that was guided researched), and even causing damage to the by the knowledge, skills, and values of social discipline.” Punch (1994, p. 83) work training. The learning resulting from this multidisciplinary collaboration emphasizes the 1. Introduction importance of the core principle of having a client-centered approach to all aspects of the “Our capacity to do research with an research process. As the purpose of research in individual is a privilege extended to us by the the social science fields is to glean knowledge research subject,” according to Cournoyer & that can be used to build a more evidenced- Klein (2000). Research is an activity that, in based practice model, the authors contend that itself, is fraught with ethical and moral multidisciplinary alliance and the meaningful decisions at every stage of the process. The involvement of clients in the process can idea of research as a privilege is often lost in greatly inform and assist the practice of the the power relations and the practical clinicians involved in research. obligations that characterize much of contemporary research. The search for Key Words: Research, ethics, vulnerable knowledge has a clear value base in decisions population, late disclosure of pregnancy, social taken over which questions need to be work, collaboration. answered and the desire to prove and disprove hypotheses. In social work and psychology, the need to understand the complexities of “Without adequate training and supervision, day-to-day life and human coping is a key part the neophyte researcher can unwittingly of any interaction and intervention. Indeed,

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve the very purpose of research in the social professions have varying perspectives, the services field is to provide evidence that can possibility to create a synergy that provides for be used to inform policy and practice and mutual understanding is described. A detailed enhance the well being of vulnerable groups discussion of the aspects of the challenges (Munroe, Holmes, & Ward, 2005, p. 1024). involved in research with vulnerable groups is Striving toward evidence-based practice is a provided with a discussion of the research contemporary development and one that has project in question outlined as an illustrative engendered much debate (Smith, 2004). example. The main ethical issues involved throughout the process of this project are This paper evolved from a collaborative highlighted to provide a sense of the research project that considered the significance of ethical consciousness at all phenomenon of late disclosure of pregnancy. stages of the research process. The paper Prior research had focused on the negative concludes providing a reflective analysis of the medical outcomes for both mother and child project and suggests some key issues for following this phenomenon, and a dearth of consideration in the practice of research with research exists in this area. Furthermore, no vulnerable groups based on the experiences, research had explored the meaning of late challenges, and outcomes of this piece of disclosure of pregnancy from the “insider” work. perspective—namely that of the women who experience it. This paper outlines how 2. Ethics and Research principles of good practice informed the research team, with the end result being a “Ethics concerns the morality of piece of research that was accomplished human conduct. In relation to social research, ethically and sensitively. it refers to moral deliberation, choice and accountability on the part of researcher In addition, the journey of the research throughout the research process” according to team is outlined, and the ethical considerations Edwards & Mauthner (2002, p. 14). The that needed to be teased through before the origins of the concern about ethics in research various steps of the research could proceed are lie within the medical sciences when the explored. The research team included two abuses in research in Nazi Germany were medical social workers and a third medical highlighted in the Nuremberg Trials. This led social worker in clinical psychology training. to the beginning of governance at an The genuine desire to explore this international level of the ethical conduct in phenomenon “from the inside” and to honor research with people with the development in the women’s experience played a central role 1946 of the Nuremberg Code. This code in molding how this study was designed and highlighted a number of key steps to be completed. A brief exploration of the nature undertaken in the research processes of research ethics within the health and social including: informed voluntary consent, services fields is presented, and an unnecessary suffering to be avoided, steps to introduction to the development of the ethical be taken to protect participants from harm, and basis to the qualitative research methodology that suitably qualified people would conduct is provided. There follows a discussion of the the research (Meltzoff, 2005). The Helsinki nature of researcher/practitioner co-operation Protocols (1964) drew out these steps further in a multidisciplinary context. As different

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve and introduced the idea of research proposals decisions to the areas of access, design and to go before ethics committees to ensure management. Thus one could reflect that greater accountability and shared research, which can incorporate enough responsibility. flexibility in devising structures and protocols to allow for the diversity and complexity of These protocols, revised in 2000, have human life, is indeed a balancing act. provided clear frameworks for research in bio- medics and in the social sciences. The World Munro, Holmes, & Ward (2005) state, Health Organization and UNESCO, who “Although researchers, policy makers and provided the frameworks for ethical research, local authorities may all work to enhance the defined participation in research as obtaining well-being of vulnerable groups, they may informed consent and respecting the right to well have different perspectives which withdraw from the research at any time. There frequently affect and occasionally undermine was little room for the interpretations of the research process” (p. 1025). This is an “participation” to mean participant important issue particularly in relation to the involvement in research design, issue of gate keeping information related to the implementation, analysis, and dissemination identification of research participants and the (Domenelli & Holloway, 2008). Domenelli level of participation, which the agency or the and Holloway identify the more contemporary professional deems to be adequate. challenges that face researchers today—issues Interpretations of the boundaries of of power, control of research processes, and confidentiality and indeed the willingness of what counts as research. With the huge sums agencies and the professionals within agencies of money involved in research, along with the to get involved in research and support the growing role of commercial interests, the drive research process is also a key part of this to reconsider ethics and research governance potential for different perspectives to has become a key issue at government level undermine research undertaken (Munro, (p. 4). Holmes, & Ward, 2005).

Shaw (2003) identifies the central 3. Researcher / Practitioner Co- questions facing contemporary social work operation: Collaboration research as social work research methodology, social work’s governance and research ethics, The desire and impetus to examine the building research capacity, and establishing area of late disclosure of pregnancy emerged research quality. In a discussion on from a learning need identified by two medical governance and ethics, he notes that the term social work practitioners working in the governance has a somber tone and “helpfully maternity department of a general hospital. emphasizes the need to take issues of They wanted to know more about the standards and ethics seriously...“(p. 112). phenomenon of late disclosure of pregnancy in However, he goes on to consider the related which women experiencing a non-marital risks that go with the preoccupation with pregnancy present late for antenatal care. governance and frameworks; in the dangers of Many of the women are often undecided about over regulation and therefore less sensitivity to whether they will parent their child post the particular ethical challenges of social care delivery. The practitioners wished to examine research, and in the confining of ethical

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve their practice with this specific population. practitioners and the researcher carefully The researcher had previously worked with the considered the likely benefits and risk to each practitioners, and thus, they had a trust in the potential participant. The practitioners researchers’ ability to work in a respectful and involved were effectively gatekeepers to sensitive manner. Therefore, the clinician’s potential research participants (Sutton, Erlen, mistrust of researcher’s motives noted by Glad, & Siminoff, 2003). This gate-keeping others (Sutton, Erlen, Glad, & Siminoff, 2003) involved balancing the need to protect was not an issue in this instance. This prior vulnerable clients with the client’s right to professional relationship was a linchpin in choose to participate, thus running the risk of bringing this research to fruition. Ongoing limiting access to potential research volunteers collaboration was an essential part of the because of well-meaning protection design and implementation of this research, (Beauchamp & Childress, 2001; Emanuel, and it took place throughout every aspect of Wendler, & Grady, 2000). the research process. The research participants were drawn 4. Researching Vulnerable from the caseloads of social work practitioners Groups: Selection of Participants who had several years’ professional experience of working with women who have Past research with vulnerable delayed the disclosure of a pregnancy. populations highlights that many of the Following careful discussion, it was deemed participants considered participation in inappropriate and/or unethical to contact research as a positive experience and linked potential participants who had experienced any this with being able to tell their story (Richards of the following: a miscarriage, a stillbirth, a & Schwartz, 2002; (Sutton, Erlen, Glad, & termination, a recent bereavement, a diagnosed Siminoff, 2003). Research has also highlighted chronic mental health difficulty, or ongoing that participants feel that by agreeing to take intervention from community social work part in the research, their story may be of services. Furthermore, some potential benefit to others. Many other vulnerable participants were not approached in cases in participants, however, experience distress which they were going through an adoption when talking about their past painful process, as it was felt that the research might experience (Cooper, 1999). potentially jeopardize this process.

One of the key issues in planning this A clinical decision was reached that it study was the balancing of the risk of would be insensitive to contact women who participation with the potential benefits of the had presented in the previous 12-month study both to society and the study period, as the experience was considered to be participants. Reference was made to the too raw and thus potentially more distressing Belmont Report (NCPHS, 1979). One of the to talk about (Dyregrov, 2004). Although these basic human rights outlined in the Belmont women had a right to participate in this study, Report is the right of participants to decide this right was at times forfeited in what whether to participate in a study or not. practitioners considered to be the best interests However, this rule may be ethically difficult to of the client. The social workers’ professional apply to certain clinical populations. Thus, the judgment was respected and accepted as valid and informed. The caveat that the welfare of

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve individuals is greater than any research 5.2. The need to research this subject question was the yardstick by which the area sensitively sampling process proceeded. Consequently, the sample was not intended to be “A considerable degree of stigma still representative of the total population of adheres to non-marital pregnancy in Ireland” women who present late in pregnancy, but (Loughran & Richardson, 2005, p. 112), and a provided an in-depth understanding of a late disclosure of pregnancy is perceived in the number of people’s individual experiences. literature to be a highly sensitive and private experience that a small number of women 5. Ethical Issues in the Research encounter (Maldonado-Duran, Lartigue, & Project Feintuch, 2000). The choices these women have regarding the resolution of the pregnancy, i.e., termination, adoption, or 5.1. Pre-planning phase: Terminology parenting also have a varying degree of stigma attached to them (Mahon, Conlon, & Dillon, A lack of clarity exists in the literature 1998). Therefore, given the documented level regarding the terms “denied” and “concealed” of stigma attached to the area of non-marital pregnancy. Consequently, at the outset of this pregnancies, a methodology was required that exploratory research process it was unclear was flexible and not predetermined in which term would best describe a pregnancy advance. that is disclosed late. Furthermore, it was unclear what terminology women who Feminist models of qualitative research experience this phenomenon would find proposed by sociologists such as Olesen acceptable, i.e., a concealed pregnancy, a (1993) and Reinharz (1992) influenced how denied pregnancy, or something else entirely. the researcher reviewed the psychological The term “late disclosure of pregnancy” was literature in this area. It was found that the preferred by the researcher as a more inclusive voices of women who have experienced this term that encapsulates the existing concepts of phenomenon had not yet been heard. A major denial and concealment but with less aim of this study was to give a voice to this pejorative connotations in describing both group of women and respect the participants’ concepts. Furthermore, the term “late involvement during the process. disclosure of pregnancy” does not assume knowledge of the processes involved in this Qualitative methods do not make claims experience. This phrase was used in about trends or distributions; rather, they aim communication with the participants in the to give a description or explanation of an event consent form. The term was also used when or experience. This was the main objective of interviewing women who had experienced this the study. Willig (2001) describes qualitative phenomenon, as it was seen as a more neutral methods of data collection and analysis as means of exploring how they related their “ways of listening” (p. 150). Furthermore, experience to terms used in the literature, such qualitative research methodology had not been as “denial” and “concealment.” used to date to investigate this area. Therefore, by using a qualitative method, the researcher could allow the women involved to “lead” the research process and tell their own stories.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Thus, to facilitate the generation of novel 5.3. Beginning phase: Establishing a insights and new understandings regarding working definition delayed disclosure of pregnancy, a qualitative methodology was employed. One of the most important initial steps in designing this study was creating a Mahon, Conlon, & Dillon (1998) have workable definition of delayed disclosure of described survey questionnaires as being pregnancy. Given the complexity of the impersonal, lacking in sensitivity, and lacking phenomenon, working definitions were flexibility, and hence, they were deemed difficult to create and only emerged after inappropriate for the present study. An open considerable discussion and constructive interview was felt to be a more suitable debate. Fox’s (2004) definition of concealed approach. McCracken (1988) referred to the pregnancy was regarded as a useful starting long interview as “one of the most powerful point. Fox defined a concealed pregnancy as a methods in the qualitative armory” (p. 9). He situation in which (1) a woman presents for proposes that, “the long interview gives one antenatal care past 20 weeks gestation (2) she the opportunity to step into the mind of has not availed of antenatal care elsewhere and another person, to see and experience the (3) she has not disclosed the pregnancy to her world as they do themselves” (p. 9). Thus, the social network. However, discussions with the researcher endeavored to explore this sensitive social work practitioners indicated that not all area by having the participants tell their own relevant cases would be encompassed by this stories in their own words, and a semi- definition. The social work practitioners structured open-ended interview was pointed out three cases where women had employed with women who had delayed the presented to the social work service prior to 20 disclosure of a pregnancy. weeks but had continued throughout their pregnancies to hide their pregnancies and who Interpretative Phenomenological disclosed the pregnancy in a limited fashion Analysis (IPA) was the method used to only. By drawing strongly on the work of analyze the data. IPA is a method stemming other researchers in this area (Fox, 2004; from phenomenology (Willig, 2001), and Wessel, Endrikat, & Buscher, 2003), and in phenomenology is a philosophical approach consultation with the social work practitioners, focusing on the world as it is subjectively a working definition was developed. Thus, the experienced by individuals, within their working definition of delayed disclosure used particular social, cultural, and historical in this study was informed by both the existing context (Giorgi, 1994). IPA lends itself well to definitions in the literature and clinical the notion of exploring an experience such as a experience. delayed disclosure of pregnancy, which is complicated, complex, and diverse. 5.4. Intermediate Phase: Contacting Furthermore, IPA has been utilized by other participants researchers to explore sensitive and personal experiences, such as sexual identity, In the interest of confidentiality, it was termination, and sexual practices (Walker, decided that the social work practitioners 2001; Robson, 2002; Flower, Hart, & Marriot, would make initial contact with potential 1999). participants. For the researcher to “cold-call” a potential participant would breach

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve confidentiality from the onset. It was decided A component of centralizing participants that it would be unethical to conduct home in the research was related to the collaborative visits as a means of making initial contact with validation process. To enhance the validity of potential participants, as clients may feel the findings, the women received a summary unable to refuse the practitioners’ face-to-face of the researcher’s interpretation of the request (Cooper, 1999). By compromising thematic findings, which had emerged from potential participants in this way, some of the the interviews. It was hoped that by being principles of informed consent would have asked for their comments and feedback, they been violated. Therefore, a telephone call from would feel they had some influence over the the practitioner to the former client was research. It was felt that this process not only deemed the most appropriate way to initiate enhanced the validity and credibility of the contact. A telephone protocol was developed findings, but it also made the research process by the researcher for the social work more democratic (Smith, 1996). Again, due to practitioners to use as a guide when outlining the private nature of the final report, the the research project to their former clients. If participants’ contact addresses were re- the participant verbally agreed to take part in checked before the reports were posted. the study, her name, telephone number, and contact details were given to the researcher. 5.6. Followup support

5.5. Anonymity, respect, and confidentiality The topic of delayed disclosure of pregnancy is highly sensitive. The researcher Based on the work of other researchers was aware that the research interviews could who have worked with vulnerable populations, potentially cause distress to the participants, (Kvale, 1996; Regan-Kubinski & Sharts- prior to, during or after the process. Hopko, 1997) and general clinical practice Participants were assured that withdrawal from principles, factors that were considered the study at any stage was an option open to included: (1) meaningful informed consent, (2) them and that turning off the tape recorder providing anonymity, and (3) confidentiality. during the interview was also an option. As an Consequently, the process by which the extra measure to manage potential distress of interview tapes would be stored, and the participants, all were informed of the transcripts anonymised, was outlined in both availability of the medical social worker to the consent form and on the day of the support them, if they so desired. Followup interview. A coding system was also devised support for vulnerable participants has been to anonymise the demographic questionnaire. suggested by other researchers (Dyregrov, Access to safe storage space within the social 2004; Sutton, Erlen, Glad, & Siminoff, 2003). work department was also negotiated and A follow-up phone call was made one week arranged prior to the commencing of the after the interview had taken place to check on research. Furthermore, the procedure to be the participant’s experience of the interview. used in the study was outlined to and approved The medical social worker took responsibility by the ethics committee in the hospital. for this task.

5.4. Completion Phase: Attempts to Participants’ right to receive counterbalance the power differential information about the findings and analysis of the research was also deemed to be important

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve not only as a means of validating the findings, were raised about the need to re-check contact but as a mark of respect for the participant’s details and ensure that their involvement in the time and involvement (Richards & Schwartz, study was kept confidential in that no 2002). Participant feedback on the findings of messages could be left anywhere for the research was very powerful. The feedback participants. Difficulties experienced by the from participants reaffirmed the belief in the social workers in trying to contact participants value of carefully listening to the voices of this in the identified sample were compounded if a hidden population. It was encouraging that the life situation had deteriorated for someone, women felt that the research had represented and the decision not to include them in the their experience accurately. One woman research was generally discussed by the highlighted that by taking part in this research, research team, which ultimately reduced the she experienced some type of validation and sample size. comfort knowing that others have experienced a late disclosure of pregnancy. She wrote: The researchers were also concerned about the personal cost of bringing attention to an It helped to see it written down on paper, that area that is so hidden for people. The cost to other women have gone through the same the participants of being reminded of a hugely thing. Before this report, I thought no one else difficult time in their lives. Thus, the ethical went through it. It helps to know that I’m not dilemmas of carrying out the research were the only person who felt these things when I always a part of the design and was pregnant and they went through the same implementation of the research. In fact, many thing with family and their partners. participants spoke afterwards about the therapeutic element involved in being a participant in the research, the opportunity to 6. Key Lessons from the project revisit the situation some time later, and that this was in fact helpful for them. The researcher’s clinical training and social work background was an important Through discussion and debate, the factor in securing the commencement and need for adequate time to be given to all stages completion of this piece of research. As a of the research process was deemed to be mental health practitioner, the researcher was paramount. First, extra time to “tune in” to able to conduct the interviews in a sensitive participants’ concerns and “where they are at” and respectful way by assuring responsive within their own personal circumstances was a empathic listening and by engagement with the key consideration. Second, extra time to participants (Dyregrov, 2004). The check back with participants, following the researcher’s clinical experience facilitated an collection of data, to ensure that this data was appropriate response to distressed reactions, if valid and representative of their experience, they arose. was essential. This attempt to make the validation process democratic can be Logistical issues experienced by the construed as not an add-on; it is instrumental researcher worthy of comment here included, in the entire process if there is to be any sense first, that the population of interest seemed to of collaboration with participants in the be a more mobile population, and concerns validation of data. In research, this is an area in which the significance of time being made

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve available can be underestimated in both the planning stages and in the philosophical The experience of carrying out this essence that guides decision-making. This piece of research is evidence that it is possible issue also extends to the time taken for to design and implement a piece of research dissemination of the research in that the that is scientific but genuinely sensitive to the participants shared their own motivation for area under exploration. The concerns of taking part in the research. Participants felt vulnerable groups need to be investigated as a that it may provide information to help others means of informing practice and research. The in similar situations in the future. To this end balancing of ethical concerns with the needs of the need to disseminate the research findings a valid and reliable piece of research is to all staff in the maternity unit once demanding but possible. The key to sensitive completed was a further link to honor the research is being led by the principles of best participants’ motivation and the underlying practice. Such principles include a client- value base of this collaborative project. centered approach that involves the clients being truly involved in each step of the project In the collaborative work undertaken design. Principles that value anonymity, between the researcher and the social work respect, and meaningful participation by the practitioners, there was a need for trust and participants with confidentiality guaranteed good clear communication. For example, in and practiced throughout in conjunction with a developing inclusion criteria, many debates collaborative approach are essential. The value arose regarding the manner in which a balance of the clinical skills of tuning in, empathic could be achieved between the integrity of the listening, and providing supportive follow-up research and the overall welfare of the were also highlighted by our experience with participants. Through clear communication this vulnerable group. Whereas collaboration and time for discussion, professional is time consuming and demands clear responsibility wasn’t compromised, and communication and respect for divergent through a shared understanding of the standpoints, ultimately, with collaboration, a principles of good practice, the research was richer, more sensitive, and considered piece of non-tokenistic. Healthy tension between the research can be achieved. roles of researcher and practitioner was evident, but through the establishment of mutual aims of the research from the outset, References and a shared understanding of the importance of respect of varying disciplines, the Beauchamp, T.L. & Childers, J.F (2001). differences in the roles became a constructive Principles of biomedical ethics (5th ed). aspect of the process. The backing of New York: Oxford University Press. management in the maternity unit to free up time for the practitioners to engage in the Cooper, J. (1999). Ethical issues and their research as well as offer follow-up support to practical application in a psychological participants where the original work was autopsy study of suicide. Journal of completed was also crucial to the process. Clinical Nursing, 8, 467-475. 7. Conclusion

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Cournyer, D. E. & Klein, W.C. (2000). Kvale, S. (1996). Interviews: An introduction Research methods for social work. to qualitative research interviewing. London: Allen and Bacon. Thousand Oaks: Sage Publications Inc.

Domenelli, L. & Holloway, M. (2008). Ethics Loughran, H., & Richardson, V. (2005). and governance in social work research Mixed method adoption research. Crisis in the UK British Journal of Social pregnancy agency report. Dublin: Crisis Work, 38, 1009-1024. Pregnancy Agency.

Dyregrov, K. (2004). Bereaved parents Mahon, E., Conlon, C., & Dillon, L. (1998). experience of research participation. Women and crisis pregnancy. Dublin: Social Science and Medicine, 58, 391- Government Publications. 400. Maldonado-Duran, M.J., Lartigue, T., & Edwards, R. & Mauthner, M. (2002). ‘Ethics Feintuch, M. (2000). Perinatal and feminist research: Theory and psychiatry: Infant mental health practice. Chap 1 in Mauthner, M., Miller, interventions during pregnancy. Bulletin T., Birch, M. & Jessop, J. (2002) Ethics of the Menninger Clinic, 64 (3), 317-327. in Qualitative Research. London: Sage. McCracken, G. (1988). The long interview: Emanuel, E.J., Wendler, D., & Grady, C. Qualitative research methods. London: (2000). What makes clinical research Sage University Press. ethical? Journal of the American Medical Association, 283, 2701-2711. Meltzoff, J. (2005). ‘Ethics in Research’ in Bucky, S., Callan, J., & Stricker, G. Flowers, P., Hart, G., & Marriot, C. (1999). Ethical and Legal Issues for Mental Constructing sexual health: gay men and Health Professionals. New York: risk in the context of a public sex Hayworth. Pp 311-336 environment. Journal of Health Psychology, 4, 483-495. Munro, E., Holmes, L., & Ward, H. (2005). Researching vulnerable groups: Ethical Fox, C. (2004). Crisis pregnancy. Western issues and the effective conduct of Health Board. Retrieved August 8, 2005, research in local authorities. British from Journal of Social Work, 35, 1023-1024. http://www.crisispregnency.ie/westernhe ath.html National Commission for the Protection of Human Subjects of Biomedical and Giorgi, A. (1994). A phenomenological Behavioural Research. (1979). The perspective on certain qualitative Belmont report. Retrieved November, research methods. Journal of 21, 2005 from Phenomenological Psychology, 25, 190- http://ohrp.osophs.dhhs.gov/humansubje 220. cts/guidance/belmont.htm.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Olesen, V. (1993). Unfinished business: The methods in the social sciences (pp. 189- problematics of women, health and 202). Oxford: The British Psychological healing. The Science of Caring, 5, 3-6. Society.

Punch, M. (1994). Politics and ethics in Sutton, L.B., Erlen, J. A., Glad, J. M., & qualitative research. In N.K. Denzin & Siminoff, L. A. (2003). Journal of Y.S. Lincoln (Eds.). Handbook of Professional Nursing, 19, 106-112. qualitative research (pp. 83-104). Thousand Oaks, CA: Sage. Walker, P.H. (2001). Sexual identity, psychological well being and suicide risk Regan-Kubinski, M.J., & Sharts-Hopko, N.C. among lesbian and gay young people. (1997). Accessing HIV–infected research Educational and Child Psychology, 18, subjects: The need for collaboration. 47-61. Journal of the Association of Nurses in AIDS Care, 8, 83-86. Wessel, J., Endrikat, J., & Buscher, U. (2003). Elevated risk of neonatal outcome Reinharz, S. (1992). Feminist methods in following denial of pregnancy: Results of social research. New York: Oxford a one-year prospective study compared University Press. with a control group. Journal of Perinatal Medicine, 31, 29-35. Richards, H.M., & Schwartz, L.J. (2002). Ethics of qualitative research: Are there Willig, C. (2001). Introducing qualitative special issues for health service research? research in psychology. Berkshire: Open Family Practice, 19, 135-139. University Press.

Robson, F. (2002). ‘Yes! - A chance to tell my side of the story’: A case study of a male partner of a woman undergoing termination of pregnancy for foetal abnormality. Journal of Health Psychology, 7, 183-194.

Shaw, I. (2003). Cutting edge issues in social work research. British Journal of Social Work, 107-116.

Smith, D. (2004). Social work and evidence based practice. London: Jessica Kingsley.

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Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Coping With Minority Status: Responses to Exclusion and Inclusion, Fabrizio Butera and John M. Levine, Editors, Cambridge University Press, 2009.

Reviewed by Michael Spivey University of North Carolina at Pembroke http://www.amazon.com/Coping-Minority-Status-Responses- Exclusion/dp/0521854997/ref=sr_1_1? ie=UTF8&s=books&qid=1282418309&sr=8-1

This edited book by Fabrizio This last aspect is what I find to Butera and John M. Levine invites be most appealing about the book. Until readers to contemplate the paradoxes recently, there has been so little and complexities of coping with research in the area that this ground- minority status. As someone whose breaking work speaks volumes about academic focus is in critical-historical the need for further investigation. The perspectives on dominant-minority reader will learn some surprising and group relations, I was pleasantly important information about minority surprised by the empirical insights and coping strategies in various everyday findings found in the text. situations. In the end, the articles here remind us of how much we take for Providing an array of social- granted about the complexities of psychological approaches, both minority group coping strategies at the theoretical and methodological, to the level of everyday interactions with study of coping with minority status, members of the dominant group. Fabrizio and Levine give us a wealth of nuanced findings which provide a fresh There are a couple of departure, and help to correct, the oft- shortcomings with the text. First, it times abstract and homogeneous would have been useful to articulate the conceptualizations and narratives of policy implications of some of the dominant-minority relations. The book findings. Second, a section devoted to is divided into three parts: 1) Coping further research would have been very with Exclusion: Being Excluded for who helpful for researchers interested in you are; 2) Coping with Exclusion for conducting future research on the topic. what you think and do; and 3) Coping The findings in the text leave so much with Inclusion. I found the last part to fertile ground for further work and it be very informative of how minority detracts from the overall appeal of the group members cope once successful text as “ground-breaking” to not, at with becoming included in the least, provide some road maps to the dominant group. Little research has future. been conducted in this area of inquiry.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve However, these are small dominant–minority group dynamics., criticisms in light of the contribution various courses in sociology and social that Butera and Levine have given us in work focusing on minority groups and this collection of fine research articles. social inequalities, as well as education It should take its place as a go-to source and business courses that deal with on the subject, both in its findings and as interpersonal relations between a bibliographical reference. I dominant and minority groups in recommend the book for courses in educational and business settings. Social Psychology which examine

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Lieberman, A. (2010). Women in Social Work Who Have Changed the World. Chicago: Lyceum Books, Inc.

Reviewed by Rasby Marlene Powell, Ph.D. Professor of Sociology University of North Carolina at Pembroke

Dr. Leiberman is a Chancellor’s Although these women’s social Club Teaching Professor of Social Welfare class, religious, and cultural backgrounds at the University of Kansas. She has are diverse, their desire for social justice published multiple books focusing mainly and the core values learned in their social on effective social work practices. Her work education connect them. All of the work emphasizes understanding diversity women claim that their social work and building upon women’s strengths. Dr. educations provided them with the Lieberman has also collaborated on several knowledge of structure and application that federally funded family and children prepared them to accomplish their goals. projects. Each of the featured women overcame structural or personal obstacles to achieve This book profiles 15 women social their accomplishments. Some came from workers who have succeeded in impoverished backgrounds; others worked contributing to profound changes in their in countries where women have few rights. communities and countries around the All of them give credit for their stamina world. Although the author does not and courage to mentors. Many cite their specify a particular audience, I believe this mothers as mentors. Additionally, many book is as suitable for a general audience credit inspiring teachers. as it is for an academic audience. Whether a person is simply interested in social This book has multiple strengths. justice or is trying to learn what practices The writing style is clear, concise, and are successful in diverse environments, this accessible to the general reader as well as book is a good choice. the social work scholar. Although the biographies are short, they provide The book is organized into three poignant and detailed accounts of various parts. The first part focuses on five social obstacles faced and successes earned by workers who have gained positions that each woman. This allows readers to see enabled them to create and change national “social work in action.” In addition, the and local policies. The second part biographies clearly show that the women features women who have created social did not have a set “plan of action” for their change from the bottom up through work but remained open and flexible so community organizing. Part III presents they could afford themselves of the biographies of three women who have opportunities. The results of their used their social work knowledge to bring willingness to change courses when great change to repressive and developing needed can inspire all of us who seek to countries. improve our communities. Whereas I really enjoyed this book, I believe it would have been improved by the addition of a

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve final chapter to tie the book together. As it purposes. I believe it would be a good is, the book just stops with the last addition to any social work practice biography. It would help students and course. In addition, this book would make general readers, alike, to summarize how an inspiring addition to gender studies what they have learned could benefit them courses. Finally, I believe that this book in their own lives or careers. could be used successfully in political science courses to illustrate how the core Overall, I would recommend this values of social work can help craft good book and believe it can serve multiple social policy.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Seccombe, K. (2011). So You Think I Drive a Cadillac? Welfare Recipients’ Perspectives on the System and its Reform, 3rd Edition. Boston: Pearson/Allyn & Bacon.

Reviewed by Peter A. Kindle, Ph.D, CPA, LMSW The University of South Dakota, Sioux Falls, South Dakota

How is it that I could earn an MSW challenged by the voices of the welfare leavers and a Ph.D in social work without being in chapters three through six. In chapter three, required to read this book? Karen Seccombe, their voices echo middle class biases against Professor of Community Health at Portland welfare; in chapter four, seven “exceptional State University, provides an invaluable circumstances” are explored to explain why resource by providing a platform for the voices these women were on welfare; in chapter five, of women who have been on welfare to speak. the financial “monotony of poverty” is Based on her interviews with 47 AFDC explored; and in chapter six, they describe the leavers in Florida in 1995 and her longitudinal formal and informal systems they used to study with 552 TANF leavers in Oregon in survive on welfare. Each chapter confronts 2002-2003, this study may well be without common middle class assumptions. Welfare peer in its ability to challenge white, middle mothers do not approve of welfare. None of class values related to work, welfare, and the “exceptional circumstances” differ from poverty. the same financial and familial pressures exerted on every woman in America. From The first chapter introduces the reader budgeting to the coping mechanisms used to to the author’s perspective, which is both bypass welfare restrictions, these women show critical in that it assumes that power time and again that they are doing what relationships favor the dominant (i.e., male) everyone does – the best that they can in group and feminist in that it assumes that difficult situations. Only a modicum of women’s experiences are devalued and imagination is required to see oneself neglected. The voices of these welfare leavers emulating their actions and decisions. blend to form an uncomfortable chorus that insists that the plight of women on welfare Chapters seven through nine turn in the cannot be easily distinguished from the direction of solving the problems these women common plight of all women, that the face. Their perspective on the strengths and presumptions of welfare reform are false, that weaknesses of the current welfare system the real problem is low wages (not welfare), undergird the author’s conclusion that the and that these voices must be heeded if social problem is the instability of low wage work solutions to poverty are to be found. without secure benefits (chapter seven). The risk associated with moving off of welfare is Chapter two provides a brief history of highlighted in chapter eight, and the reader is welfare and a sketch of the explanations for confronted again with the harsh truth that the poverty along a dimension running from security welfare supports represent may make Individualism to Social Structuralism. This the risk of leaving welfare untenable. The historical and theoretical framework is then concluding chapter argues for more resources

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve to be devoted to the safety net and compares author continues throughout this text to the inadequacies of the safety net in the United conflate the two. In fact, she fails to States to other countries. acknowledge that there may be a qualitative improvement in a family’s life when In many respects, this book is without employment replaces welfare, no matter how flaws. The central purpose, to help us hear the poorly the work pays. voices of women who have been on welfare, is a fait accompli. The author’s ear has been so Thirdly, I suggest that the author more well-tuned to their voices that she does not critically evaluate her solutions in chapter always seem to appreciate how these voices eight. This reviewer is unconvinced that the might resonate in the ear of the readers. This is history of job training programs, for example, a book I would like every social work student warrants endorsement, or that court imputation to read and discuss, but it is also a book that I of child support on unemployed or would like to hide from my more conservative incarcerated fathers has proven an effective friends. solution to the absent father problem. “The simple truth is that not all adults are In order to broaden her reading psychologically, intellectually, and physically audience, I believe the author needs to address capable of financially supporting themselves three things that are not adequately covered in and their families” (p. 165) seems to indicate this book. First, I suggest that she include an that social investments in human capital will analysis of the impact the Earned Income Tax never solve the problem of dependency. Credit (EITC) may have on the transition from Accordingly, while this reviewer endorses the welfare-to-work. Even a modestly aware critic criticisms of the low wage employment sector of the welfare safety net realizes that it is a recorded here, he is not convinced that the hodgepodge of programs. Why not simply “problem with welfare is the structure of low- include a table describing the financial impact tier work” (p. ix). This is part of the problem. TANF, food stamps, low wage work, Section 8 The other part is that our society has failed to housing, transportation vouchers, child care face the realities of dependency. support, Medicaid, and EITC might have on a typical family? Without explicitly informing I loved reading this book and the reader in this manner, the author allows the recommend it highly to all social work reader to invoke the iceberg principle – that instructors and students. I will definitely be she is hiding something that is larger and more using it in my classes. Practitioners need to important than what she is telling us. hear these voices and reflect on their meaning. Those who do so will be enriched by the Secondly, I suggest that the author experience. more clearly distinguish between welfare (a product of dependency) and poverty (a product of scarce resources). One may escape Reviewer Contact information: dependency without escaping poverty, but the [email protected]

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Book review of International Social Work Professional Action in an Interdependent World 2nd ed., by Lynne Healy http://www.us.oup.com/us/catalog/general/subject/SocialWork/? view=usa&ci=9780195301670

Reviewed by Angelika Groterath, Ph.D. [email protected] University of Applied Sciences of Darmstadt, Germany.

Background such a book is a challenge, to read the review ditto, all the more if the reviewer adds The first edition of this book was published amendments as I do. I apologize to the in 2001. The second edition has been revised reader, but first of all to Lynne Healy for remarkably; it responds to events and doing so. And I hope my amending will be developments that occurred in the period understood as deemed. I want to add a little between 2000 and 2007 such as the terrorist more knowledge to this rich volume in order attacks on New York and Washington, D.C., to increase the extensive knowledge about in September 2001, and natural disasters international social work that Lynne Healy such as the Tsunami, and also the increasing has already provided. concern of schools of social work about international contents and global standards My amendments refer mostly to UN issues. for education and training. The primary As Katherine Kendall, undoubtedly one of market of this book is North America, but the international pioneers, notes in her Healy has enhanced the global relevance of foreword to this second edition, “neglect of the text, since demand from other parts of the international content in the social work world has been considerable. The volume is curriculum is perhaps due not so much to impressive and provides content that covers lack of interest on the part of faculty almost all facets of international social work members, but rather to lack of knowledge, such as the history of the profession in an particularly knowledge drawn from first hand international perspective, its collaboration experience in other lands” (ix). I have such with international organizations such as the firsthand experience from working in other UN, the functioning of international lands and from working with the UN in the organizations, theories and concepts 90s and the early Millenium and think it underpinning international social work, might be useful to add some information. international relief and development practice, Healy relies for her reporting about UN the international/domestic practice interface, bodies, activities, and mechanisms mostly on mechanisms of and experiences with elder secondary literature, sometimes on international exchange – and more. The 371 unclear sources and often on personal pages are supplemented by five appendixes communications, dating from the 80s and and a glossary of terms and abbreviations. earlier. The UN, as the whole world, had to face changes and challenges in the last 20 “Comprehensiveness, of course, is years, which had been unpredictable, and this impossible, especially when tackling such a dramatically impacted not only policies, vast topic area, and therefore power distribution, and concrete activities, comprehensiveness is a strength and a but also the human resources policies and weakness of the book. There are many needs of international organizations like the omissions and other areas that deserve much UN. more depth” (xv) – apologizes the author in the preface to the second edition. To review The book

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Healy explains “international action” further Throughout the book, which consists of four as having four dimensions: “internationally main parts and fourteen chapters, the author related domestic practice and advocacy, gives empirical examples, mostly in boxes in professional exchange, international practice, the text, referring to sources such as and international policy development and “personal communication” or “case adapted advocacy” (10). Expecting that the four main from …” or own narratives on IASSW parts of the book refer to these dimensions, events she had participated in. A chapter on i.e., that each part is concerned with one of “International Relief and Development them, the reader remains, however, Practice (p. 260-286) that disappointed: The topic area is simply too provides a deeper insight to field practice is vast. written by Lara Herscovitch, Education Specialist of Save the Children, with the Part I: The Context of International Social author. Work: Concepts, Issues, and Organizations (25-132) In an introduction chapter, Healy points out why international social work is important Part I consists of four chapters. The first (“globalization”) and what it is. The focuses on the main concepts and theories profession has not yet agreed about a underpinning international social work: common definition. Many include a social worker working or collecting data in another “Globalization” is a critical term for social country, as well as social workers from work, which has paid considerable attention different countries coming together and to the negative impacts of globalization and discussing practices or cases in their home has difficulties to develop “a shared countries. More appropriate, in the opinion of awareness of the world as a single place” (26, the reviewer (and presumably also in the Healy quoting Midgley, 1997). The impact of opinion of the author) is a definition from global interdependence has been well 1957 by the U.S. Council on Social Work understood in economic and environmental Education: matters, but less well in social work. This gap in comprehension is “particularly acute “ … that the term ‘international social work’ in Western nations” (28). Social workers in should properly be confined to programs of poorer countries have been living with the social work of international scope, such as impact of global interdependence for many those carried on by intergovernmental years. Healy points that out and gives agencies, chiefly those of the U.N.; examples, but chooses two examples that are governmental; or non-governmental easily understood in social work practice in agencies with international program” (Stein, industrialized countries: Migration as the 1957, p.3 – Healy, p. 8). most dramatic social indicator of globalization (with many more migrants in Healy extends this definition, however: “… poor countries then in the rich “fortresses,” international social work is defined as as she notes) and the rapid spread of international professional action and the HIV/AIDS. capacity for international action by the social work profession and its members” (10). “Development” is, to Healy, “still not a “International action” is vague. Thus, a widely understood concept among Western German social worker who finds a job in (or Northern) social workers” (52). She Austria, not with the UN in Vienna, but in a references definitions and theories, and kindergarten in Innsbruck, could claim to be focuses on “social development,” a an international social worker? Not really. development concept “particularly important

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve to social work” (56), and tries to link up But Healy’s opinion that a “much more social work definitions to UN definitions or comprehensive measure was developed by concepts. social work scholar Richard Estes” (61) does not really challenge the HDI: Estes’ Index of The references to UN sources are critical Social Progress (ISP) comprises 45 throughout the book. indicators, among them “political chaos,” “cultural diversity,” data and amount of data In this chapter, Healy quotes “Food and that are difficult to collect – at least in poor Agriculture Organization, International Fund countries. for Agricultural Development, UN Centre for Human Settlements, World Food “Human rights” are “also increasingly at the Programme, 2006” as authors of a quotation core of international social work” (63). The on the degradation of ecosystem services. author gives an overview, explains what The reviewer, knowing FAO, IFAD, both of treaties and conventions are. And she points them specialized agencies, and WFP, out which conventions are important for subsidiary organ of the General Assembly, social work. A core subject in the discussion all with their headquarters in Rome, quite on human rights inside the international well and UNHABITAT, the UN Human community is the universalism vs. relativism Settlement Program (UN Centre for Human debate, i.e., the plea that is raised by Settlements is the former name) a bit, was representatives of poorer countries for astonished: What will these organizations, recognizing the Western bias in the Rights. different in history, mandate, funding, and Healy, who has looked further into this other, have written together? Healy refers to subject, dedicates her own chapter to it in a paper presented in a session of the part III of the book. In this section, she refers International Forum on the Eradication and UN failures as the non- or too-late reaction in Poverty that took place in New York in cases of genocide, explains the principle of November 2006. The session was, indeed, state sovereignty – and comes up with organized by the ‘authors’, but the whole introducing the non-governmental Forum was an interagency initiative with international actors, i.e., the NGOs. about 15 UN agencies participating. The moderator of the session was from FAO; Another chapter in Part I deals with global among the panelists were representatives of social issues that are relevant to social work: NGOs as Bread for the World. (see Poverty, no longer contained within national http://www.un.org/esa/socdev/poverty/Povert boundaries; The status of women with related yForum/Documents/bg_1.html, retrieved subjects such as gender violence and the 14/11/2009). question of traditional practices, i.e., FGM; problems of children in difficult More information about UNDP (United circumstances, i.e., child labor, street Nations Development Program) that draws children, child soldiers, etc.; aging, a on the expertise of developing country problem of the industrialized nations, and nationals and NGOs, would have been natural and man-made disasters. helpful. Healy criticizes, instead, the Human Development Index (HDI) developed by two The final chapter is on “International Social economists from Pakistan and India Welfare Organizations and Their Functions.” respectively and included in UNDP’s Human It is ambitious to call UN agencies ‘social Development Report(s). The HDI with its welfare organizations’ and not correct in the three main indicators for development is opinion of the reviewer. The UN is an criticized by many, first of all India, ranking intergovernmental international organization. low in the index (134 out of 180 in 2009). The UN system is undoubtedly a unique

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve system of universal competencies; but it is Agencies” (108) the ECOSOC (the complex, not primarily interested in “social Economic and Social Council) and “major welfare” and not even democratic. Healy UN agencies related to social welfare.” a describes under “Current UN Structures and description the reviewer would like to revise:

Healy (108ff) Groterath ECOSOC “reports to the General Assembly” is as the General Assembly (GA) one of the 6 (5 – the Trusteeship Council Economic suspended operations in ’94) main and Social organs of the UN – assists the GA – 54 Council member States are elected by the GA on the basis of geographical representation.

“operates through four standing “operates” less then it did before, since committees” and has “coordinating subsidiary organs mainly of the GA functions” have taken over parts of the operation and coordination. ECOSOC serves as a central forum, assists in organizing international conferences and has an own subsidiary machinery including commissions, standing committees, expert bodies, etc. Its relationships to other agencies and bodies are non- subsidiary; i.e., they are not direct reporting relationships. ECOSOC has lost much of its concrete power, but remains - in the eyes of the author (reviewer) – “the grey eminence” for economic and social matters in the UN.

one of the committees is the This (standing) committee is of committee “Non-Governmental outstanding importance for other Organizations” international actors, i.e., the NGOs, which can apply for Consultative Status with ECOSOC. Healy explains, what such status is, in Part II of her book. UNICEF “is an important agency of the UN” UNICEF was and is a subsidiary organ “it became a permanent agency ...” of the GA, belonging to the group United ‘Programs and Funds’. It might Nations resemble the ‘specialized agencies’, Children’s which are permanent (but not called Fund “permanent agencies”), such as WHO and FAO; but it is not a specialized agency. It has evolved from an emergency fund to a development agency.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve “with a focus on development” not more or less “development” than other UN agencies; UNICEF’s focus is on children; the shift was from emergency to development. UNDP “UNDP is the largest operational Is the UN’s global development development agency in the UN network, a subsidiary organ of the GA, United system” group “programs and funds.” Nations Develop- “UNDP … plays a coordinating role All UN entities involved in ment among all the UN entities involved development can hardly be coordinated Program in development” by one agency: UN agencies are not necessarily “friendly” with each other, but compete; and they differ in status in the UN system in funding, power and some other things. What UNDP has set up in developing countries is the United Nations Development Assistance Framework (UNDAF), composed of UN teams present in the country, under the leadership of the local UN Resident Coordinator (RC) who is in most cases the UNDP resident representative. The frameworks coordinate their responses to the development needs in the country; the RC, who is also the representative of the Secretary General in the country, coordinates humanitarian assistance in cases of emergencies as natural or man-made disasters.

”It administers the UN Development That is true, but it is worthwhile to Fund for Women (UNIFEM).” mention that UNDP also administers the United Nations Volunteer Organization (UNV) which is interesting for social workers. WHO “WHO is another specialized None of those mentioned above is a agency of the UN.” “specialized agency.” World Health “international health issues” – All true, but WHO has two directorates, Organization “international health standards” – which are of interest for social workers: primary health care” – “Malaria” Non-communicable Diseases and Mental Health with a department of Mental Health and Substance Abuse; and Family and Community Health with ‘Ageing and Life Course’, ‘Gender, Women and Health’ – and some activities more.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve …. a quotation on AIDS education, The joint program is UNAIDS, a highly prevention etc. … by “(Joint UN interesting program for social workers Programme on HIV/AIDS, 2006)” that could have been listed here – instead of FAO, for instance. UNFPA “UNFPA is the largest source of UNFPA is a subsidiary organ of the GA funds for family-planning-related and entirely funded by donations. The United programs in developing countries.” biggest donor was for a long time the Nations USA. Population Fund “Funding support from the United States was greatly curtailed beginning in 1984 when the United States government cut off all funds for organizations that supported or permitted abortion services. This ban was reversed in 1993 and reinstated by President George W. … and Obama announced that funding Bush at the beginning of his term.” would be restored. UNHCR “Originally created as a temporary Subsidiary body of and created by the agency .…” General Assembly in 1950 with the United mandate of “international protection.” Nations High Commission “We need lots of social workers!” – er for Personal communication by a UNHCR Refugees senior staff counselor, July 2009. FAO “The first of the UN specialized That is true, or better: it is one of the agencies created, the FAO’s goal is specialized agencies, the “first” in the Food and to work toward global food listing by alphabet. These are Agriculture security.” autonomous organizations working Organization with the UN and with each other through coordinating at intergovernmental and inter-secretariat level. But what has FAO, the lead agency for agriculture, forestry, fisheries and rural development, to do with social welfare, i.e., why should the FAO be one of the “UN agencies related to social welfare” (see above), or be of interest to social workers? WFP “With the UN, the FAO sponsors The World Food Program is the world’s the World Food Program, … largest humanitarian organization. It is World Food a subsidiary organ of the GA, funded Programme entirely by voluntary contributions (a ‘donation agency’); and it is independent from the FAO. The biggest donor is the USA.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve which supplies 25% of the world’s This might be true, but is regrettable: food aid.” the WFP is a humanitarian, not a development agency, the biggest one; and food is supplied by WFP in emergencies and after emergencies to help communities to rebuild their lives. What has this to do with social welfare? The WFP has no particular need for employing social workers, with one exception: Staff of humanitarian agencies as the WFP, also in charge of logistics and communication in emergency operations, is highly at risk, physically and mentally. A counselor team in HQ and in the field supports the staff on mission and after return; and social workers belong to that team.

References: Groterath: firsthand experience and “The United Nations Today,, United Nations Department of Public Information, New York, 2008.

Further to the UN agencies, governmental Part II: The Profession Internationally agencies are listed under “International (133-235) Social Welfare Organizations,” but it is made clear that these are only in parts concerned “The History of the Development of Social about social welfare. “It is important for Work” (135-163) relates to the origins of social workers to understand that social work in industrialized countries, which international assistance serves many had to meet the “by-products of the industrial purposes for the donor nations and that revolution” (136), the spread beyond North humanitarianism is often not the major America and Europe in a second phase and consideration” (117). Healy relates then on World War II and the Nazi Period. comprehensively about bi-lateral aid by That brought out “the worst in the profession USAID, the US Peace Corps inclusive, and of social work” (145), particularly in by Japan and the Nordic Countries Germany. The examples from post-war (commonly the most altruistic and Europe, particularly the Eastern countries, progressive) and mentions then as the last with some exceptions, aren’t encouraging category of “International Social Welfare either. From an American point of view, Organizations” the nongovernmental however, “the restoration period following organizations. The overview given in this World War II can be described as a rich part I is comprehensive, if not short – one cornucopia filled with international example with Save the Children, short notes programs, projects and opportunities” (152, on the difference between relief and quoting Kendall). These were opportunities development and some ideas about areas of mainly for American and British social action – but Healy comes back to the NGOs workers, as the reviewer would like to note: and particularly to Save the Children in other These got involved in the UNRRA program. parts of the book. UNRRA was the United Nations Relief and Rehabilitation Administration, founded during World War II by the USA, UK, the

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Soviet Union, China, and about 40 other another era of indigenization will emerge for nations under the guidance of U.S. President the countries of the East” (157). Roosevelt, to provide relief to countries and peoples that were liberated from the enemy, Interesting and fascinating is the collection of i.e., the Axis powers. President Roosevelt biographies of the pioneers of social work has, indeed, coined the name “United from Denmark (Manon Luttichau), Germany, Nations.” But these UNRRA “United then UK and the USA (Alice Salomon), Nations” were not what we know today as Poland (Irena Sendler), Jamaica (Sybil United Nations. Unfortunately, Healy does Francis) and Iran (Sattareh Farman not explain that. Sentences like “Building on Farmaian) that are presented in boxes in the the UNRRA programs …, the UN soon text throughout this chapter. This collection became the largest contributor to the spread of biographies continues in the next chapter of social work in a number of developing on “International Professional Action, A countries” (152) mislead the reader, may they Selective History” with portrayals of in parts be true (the UN used, of course, the Eglantyne Jebb, founder of Save the relief and rehabilitation experience of Children; René Sand, a founder of the ICSW UNRRA and some of the UNRRA staff got and the IASSW; Donald Howard, social employed by the UN) and may they be said worker in UNRRA; and Dame Eileen by the author herself or by Younghusband, to Younghusband, the author of the 3rd Global whom she refers. Other developments in the Survey of Social Work Training for the UN. “career” of social work with the United In this chapter, Healy describes how social Nations (those of today) reported, cannot be work takes the world stage by collaborating verified. Healy quotes Garigue, who has with and founding its own International made a contribution to the Ninth Annual Organizations. The three major international Program Meeting of the U.S. Council on social work organizations, IASSW, IFSW, Social Work Education in New York in 1961 and ICSW, developed out of The and who said that in 1959, the ECOSOC had International Conference of Social Work in asked the UN Secretary General to do 1928 in Paris, are described in detail. IASSW “everything possible to obtain the was engaged mainly in promoting and participation of social workers in the developing education and training preparation and application of programs for internationally, IFSW was promoting the underdeveloped countries” (153, quoting profession and as standing for The Garigue). True or not: Many countries International Code of Ethics, and ICSW was received assistance in the period of the organization that maintained active independence movements / decolonization, liaison with the UN on social development and most probably also by social workers matters. On this occasion, Healy explains from Western nations, whether these were what a Consultative Status with the UN is: acting on behalf of the UN, bilateral aid “The system for NGOs to interact with the programs or the Peace Corps. And the “Era UN was established in 1946 and remains of indegenization: The 1970s” (153ff) that largely unchanged today. Organizations are followed was characterized not only in social permitted to apply for consultative status work matters by “strong anti-American with the Economic and Social Council feelings developed along with a rejection of (ECOSOC) if they meet several conditions: the process of borrowing and using models They must focus on issues related to from the industrialized countries” (156). ECOSOC, have aims consistent with the UN Another “model-colonization” then took Charter, and broadly represent those in their place after the fall of the Eastern bloc, when field (with a preference for worldwide “a flood of consultants” (157) arrived in organizations rather than national bodies). Eastern Europe. Healy: “It is likely that NGOs can be accepted into one of three

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve classifications, with varying privileges. national model and who speaks only English ICSW is a Category I organization, will hardly be able to work with the UN if designated as an organization “with a basic not for politically motivated reasons. interest in most of the activities of the Knowledge of at least two languages, Council” (Willetts, 1996, p.32” (183). Healy preferably UN languages (Arabic, Chinese, does not explain this concept further, which English, French, Spanish, Russian), is a basic is regrettable, since Category II, Special requirement for working with the UN. Consultative status, is an interesting category for social work also, ditto, as a “starter,” the The chapter on “Social Work Around the Roster Category III. World Today” (201-235) gives an interesting insight into social work education and Further to the International Social Work practice in countries such as Denmark, Japan, Organizations — as a fourth major Armenia, and Ethiopia, among others. It is international social work organization— the obvious that the differences are remarkable International Consortium for Social and interesting, and it is encouraging to find Development is mentioned, but not described all these country reports in one book. in detail. Healy reports about “Direct Work Denmark is the only European country in International Organizations” and gives described. The American glance at Europe three examples. There is also a small section needs getting used to, but is refreshing: “As on “Inside Influence at the United Nations” have many other European countries, where pioneers such as Katherine Kendall Denmark has joined the Barcelona are cited, all enthusiastic about working Convention, which validates educational experiences with the young United Nations, comparison and allows student mobility. This and the true United Nations as a referral to system is facilitated by a joint European the first meeting of the Social Commission of Credit Transfer System (ECTS points)” ECOSOC in 1947 (190) lets suppose. The (204). Barcelona?! She obviously means “American-British bias” or predominance, Bologna, i.e., the Bologna Process. Never however, is not raised as a topic: “…. and mind! If only the system was already social welfare officials from developing facilitated … . countries were given UN support to study social work in the United States and Great Britain” (191). Among the reasons for the Part III: International Social Work: decline of inside influence of social work (in Values, Practice, and Policy (239-337) the UN) that the author suggests is much about emphasis on economic development, This is the part of the book where the author increasing bureaucracy, as well as the brings up the important debate on difficulties of the profession to adapt to universalism vs. cultural relativism, a debate challenges and new circumstances and to truly relevant not only to social work. compete in interdisciplinary environments. Concepts like self-determination, But there is nothing about this bias in a new independence, non-directivity, environment of international politics. In the confidentiality, i.e., core concepts of social post-war period (and confusion), with work, seem to be grounded in Western decolonization beginning and only 51 UN individualistic culture; and they are member states, the USA and UK were, if not questioned and challenged by authors, the only ones, but the dominant ones to officials, and further representatives mainly impact international policies. A lot has from Africa and Asia. The question is changed meanwhile, starting from the described and discussed thoroughly. Without number of member states that increased to a proper knowledge of the universalism- 192. Today, somebody who knows only one relativism debate and an appropriate self-

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve positioning, a social worker can or should, able to take such a job or not. David Bourns indeed, not act on international stages. Lynne works with Save the Children and holds a Healy proposes moderately relativist or Master’s in Social Work degree. In the moderately universalist positions. opinion and the experience of the reviewer, Donaldson, for instance, proposes a set of the remarks on the unsustainability of a core human values to be respected as “an number of classical psychological or absolute moral threshold” (255, quoting therapeutic interventions (274) are important. Donaldson) to be mixed with respect for Trauma counseling should, indeed, be local traditions and the context – a good provided, if ever, only under conditions of a example for a moderately relativist position guaranteed appropriate and sustained follow- in the opinion of the reviewer who up mechanism – and not in every possible recognizes her own position. form / method, as could be added. True, interesting, and encouraging for the reader is The second chapter in this part III is written also what is said about networking by Lara Herscovitch, Education Specialist of possibilities in the field. NGOs are working Save the Children / USA, with the author. together with UN agencies and other This chapter informs thoroughly and in detail internationally active bodies. The on field practice, introduces the relevant institutional gap is much smaller in the field glossary and related concepts and mentions a than in Headquarters, and meeting and debate, which is important in current collaboration is easier – and in relief international politics and technical operations often facilitated, as could be cooperation, i.e., the debate on relief and/or added, by OCHA staff. OCHA is the UN vs. development. The modern relief vs. Office for the Coordination of Humanitarian development landscape has, indeed, changed Affairs. as the authors note (261). “There is an increasing understanding of the issues that In another chapter in part III, Healy discusses connect relief and development work and the “International / Domestic Practice how one can pave the way to the other. For Interface” (286-316), affirming that “all” example, poorly planned agricultural social workers “are likely to engage in practices – typical development work – can internationally related social work within cause soil erosion or deforestation, which can their usual jobs” (286) – with migrants, cause severe landslides during a heavy rainy refugees, in international adoption, through season or hurricane thus leading to the need interpreters, in inter-country case work, and for relief work” (261). Particularly in border areas. “It is hard to imagine a social interesting for the readers of this book, work career in the twenty-first century that supposedly social workers interested in will not bring the practitioner into periodic getting involved in international business, is contact with situations that require the section about employment of social knowledge beyond the borders of one’s own workers in internationally active NGOs. country” (313). True – but she / he has There are lots of possibilities, as the authors interpreters at hand if needed, represents the report, even though many of the vacancies power, can insist in being on the right side, are not vacancies exclusively for social acts on behalf of national authorities, etc. workers. International jobs are definitely And this would require an in-depth more generic than domestic ones. A social discussion. worker who reads David Bourns’ report about “A Day in the Life of a Program The last chapter in part III is dedicated to the Manager,” one of the empirical examples in a question of “Understanding and Influencing box in this chapter (270-271), can certainly Global Policy” (317-337), an important develop an idea of whether she / he would be question, and an important requirement for

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve working in the international fields. The Wagner, who wrote in 1992 about social author gives useful advice concerning policy work education in an integrated Europe and making organizations and argues again for a had probably the transfer from Western social work involvement in international models and ideas to post-sovietic Eastern politics. Indeed, with issues such as poverty, Europe in mind, is that “social workers and HIV/AIDS, gender, etc. (see above), on the social work educators probably have more global agenda, an involvement of social affinity with the concept of unilateral transfer workers (or, as the reviewer would propose, than with the concept of exchange, because it “soft skills experts,” and this term includes is based on altruism, rather than economic other professions) makes sense and should transplantation and self interest (p.126)” meet demand. Particularly the Civil Society, (344). If this is true, i.e., if social workers i.e., the NGOs and the NGO Committees at from industrialized countries believe that the United Nations, have moved a lot in their own domestic practice is the best and recent times. They could be an excellent that they could not learn from others – they forum for social workers if social workers, as should stay at home. As Healy notes the other professionals, were ready to engage in increasing global dialogue has diminished more generic jobs, to leave apart some of western dominance and fractured the their domestic professional convictions and predominantly Anglo-Western pedagogical attitudes, and do not try to use these forums hegemony. Among the examples of exchange as professional vanity fairs. Lynne Healy practice, the European situation is discussed, uses this chapter to integrate some of what i.e., the Erasmus program, an attempt to has been said and explained before and gives “promote Europeanization” (350) by the EU. advice on how to use the international The Erasmus funding has enabled many machinery to influence international as well students to have exchange experiences, but as domestic policy. But influencing policy is is, from the point of view of Non-Europeans “a big thing” all the more if it is global (and probably some Europeans, the reviewer policy. Much lobbying is necessary; and inclusive) “Euro-centric” (351). lobbying can be done by individuals, but is often more efficient if done by organizations A small, however, important section in this or associations. Not surprisingly, Lynne chapter on exchange treats the “Paradigm Healy concludes this chapter with an appeal Shift in International Exchange” (352). This to the international professional shift is from emphasis on experience to organizations to expand their efforts in policy emphasis on competence. Healy quotes influencing. Albach & Teichler, 2001: “The traditional ideal of a cultural experience has been superseded by the goal of obtaining IV Strengthening International Social knowledge useful for the new Work: Strategies and Challenges (341- internationalized professions of the 371) postindustrial era” (352). And this is good and bad news, according to the author – and In the first of these two last chapters in part more good and less bad news, according to IV, the author discusses international the reviewer who considers the cross-cultural exchange modalities and questions. Hardly experience and its impact on personal growth anybody doubts about the usefulness of or transformation not the core, but an added international exchange – if not social value of exchange. workers?! “Exchange is likely to occur only when each party to the transaction has Healy’s last chapter is called “Social Work as something of value to transmit to the other” a Force for Humane Global Change and (344). And a hypothesis of an author called Development” (357-371). She uses the

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve chapter for summarizing, for a “de-briefing” international scene than in terms of sameness as would be said in terms of international or university” (369). practice. In the conclusion, she comes back to her definition of International Social Conclusive statement by the Work, a definition, that emphasizes reviewer “professional international action in a globalized world” (369), taking position I am sure that Lynne Healy could already against universalism: “International social open up the minds of many students of social work indeed transcends national boundaries work by her commitment, her work, and by and gives social work a global face, but more this book, and that she will continue to do so. so in terms of actions and presence on the This book merits to be read and to become a basic textbook for students of social work.

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Garfinkel, I., Rainwater, L. & Smeeding, T. (2010). Wealth & welfare states: Is America a laggard or leader? New York: Oxford University Press. http://www.oup.com/us/

Reviewed by Laura Gibson, PhD, MSW, LCSW

Irwin Garfinkel is co-director of the is to promote human well-being and to address Columbia Population Research Center and the social conditions in a way that helps society Mitchell L. Ginsberg Professor of meet the basic human needs of its members. Contemporary Urban Problems at Columbia This book makes a significant contribution to University’s School of Social Work. He is the that mission. chair of the Social Indicators Survey Center, which conducts research on inequality and The authors begin by explaining that survey methodology. all rich nations have large welfare states, and that the socialized portion of welfare states Lee Rainwater is Professor Emeritus of works, along with capitalism, to enrich Sociology at Harvard University and a founder nations, not strangle them. They discuss the and research director emeritus of the domains of healthcare benefits, pensions, Luxembourg Income Study. education, cash transfers, and in-kind benefits. Particularly timely is the discussion about Tim Smeeding is the Arts and Sciences whether the U.S. gets its money’s worth for Distinguished Professor of Public Affairs and healthcare expenditures. The authors go on to Economics at the University of Wisconsin’s discuss how welfare state programs La Follette School of Public Affairs and redistribute income across the life cycle and director of the Institute for Research on across income classes and the effects this has Poverty. He is also founder and director on inequality, education, and health. The emeritus of the Luxembourg Income Study. authors assert that historically, America has been a laggard in poor relief, but a leader in This book explains why all wealthy providing mass education. nations, including the United States, have large welfare states and how these welfare states in The unique political history of the U.S. fact contribute to the wealth of these nations. is described, as well as the influence of the With backgrounds in social work, sociology, American Creed on the unity of the American and economics, these authors write to “the people. The authors state that the U.S. faces largest possible audience, citizens of all three major challenges for the future: making nations,” but especially to social scientists. It Social Security fiscally sound, achieving would likely be appropriate for Masters- or universal healthcare while containing costs, Doctoral-level students. It would also be and restoring excellence to the educational appropriate for those teaching economic and system. social sciences courses at all levels. One of the book’s greatest strengths is Although not explicitly about social that it reflects the multiple perspectives of work values and ethics, this book is very authors from different professional disciplines: relevant to social work in that it does provide social work, sociology, and economics. This the social and economic underpinning provides a broad, thorough discussion of necessary to more fully understand and apply issues that includes both a social and economic the profession’s values. NASW states that the context. The authors also do a fine job primary mission of the social work profession explaining some very complex ideas, which

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve are presented in a logical fashion. It appears to right’s” failure to expand access to higher be well researched, and economically-related education. Using this logic, it is conclusions are based upon facts that are understandable how access may be related to supported by data. Politically-related completion rates, but the explanation for low conclusions are not as strongly supported by test scores is unclear. I would like to have seen objective data. this outcome measure explored further.

The authors report measures of I would recommend this book for education attainment that include (a) the level master’s and doctoral level students and for of education and (b) scores on achievement educators teaching social policy classes. It tests. They state that the U.S. has lost its seems a bit beyond the grasp of undergraduate dramatic lead in terms of college completion, level students. and it is nearly last in terms of average achievement test scores while spending more on education than other rich nations. They link the decline in education to the “political

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Franklin, Samuel S. (2010). The Psychology of Happiness: A Good Human Life. Cambridge, NY: Cambridge University Press. http://www.cambridge.org/

Reviewed by John R. Bowman, Ph.D. University of North Carolina at Pembroke

According to its publisher, this something very different than it does book is the first work to synthesize today. According to Franklin, for the psychological, philosophical, and ancient Greeks, ethics was concerned with physiological research and theory in the problem of how to live a good human support of Aristotle’s concept of life, and far less concerned with rules of happiness, or eudaimonia. The book’s conduct that governed social behavior or author is Professor Emeritus of Psychology professions. at California State University, Fresno, and Professor Franklin’s life’s work has The Psychology of Happiness is focused on the psychology of happiness, highly recommended for those readers especially as it relates to the development interested in making connections between of virtue and human potential. Aristotle and the evolution of modern psychological theories, and for those The book is divided into seventeen individuals wanting a better understanding chapters and begins with an examination of Aristotle’s notions of moral virtues of “What is happiness?” and some of the essential to happiness. The author clearly alternative meanings of happiness. From has a passion for and a deep understanding Franklin’s point of view, happiness is not of Aristotelian thought and he elaborates simply pleasure, nor is it necessarily the complexities of Aristotle’s concepts related to the accumulation of wealth. and ideas in an engaging, logical, and Rather, happiness according to the author fairly understandable way by using “is a way of living that enables us to fulfill examples from everyday life. potentials and move toward a good human life” (p. 12). Professionals in the fields of social work and ethics will appreciate the After reviewing the theories of thoroughness to which the relevant Maslow, Rogers, and Erickson and their philosophic and scientific literature is concepts of fulfillment (or self-realization reviewed. Readers too who are interested or actualization), Franklin argues that in moral philosophy, the history of much of humanistic psychology is based psychology, and psychological views of on Aristotle’s idea of actualization, and virtue development will find this work that Aristotle was the originator of the very useful and fascinating to read. notion of happiness as fulfillment. In fact, according to Franklin, his book was Despite its title, this book is not actually inspired by Aristotle’s intended for the general public who will Nicomachean Ethics. It should be noted likely find this volume difficult to read. that for the Classical Greeks, ethics meant And for those readers who are looking for Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve a readily accessible practical guide to philosophy, this book offers little in the happiness, this book may not be for them, way of actual practices and exercises for either. Having an understanding of cultivating happiness in one’s personal or Aristotle’s notion of moral values, and his professional life. premise that virtue is a means of self- fulfillment and a prerequisite for happiness, may or may not contribute to John R. Bowman, Ph.D. individual happiness if one does not have Professor, Department of Sociology and an understanding and knowledge of Criminal Justice concrete practices for creating happiness in University of North Carolina at Pembroke one’s life. Although Franklin has an Pembroke, North Carolina 28372 excellent grasp of Aristotle and his

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve my book editor extraordinaire, and became a Professor, Siena College dear beloved friend. Her outer beauty first took my breath awa,y and then later, the Lisa was our steadfast support throughout inner beauty astounded me by its sweetness our writing Social Work and the Web for and gentleness. Indeed it still does and Brooks/Cole. She was a wonderful mentor really is a model of generosity that I will and colleague, always cheerful, insightful, always hold close. I am so grateful for and very connected to the needs of social Lisa's deep love shared as with "shattered work. Her generosity, sensitivity, and alabaster." warmth were so wonderful. We miss her voice, her humor, and her singing! Kia J. Bentley, Ph.D., LCSW Virginia Commonwealth University Darlene Lynch and Bob Vernon, Indiana University School of Social Work Lisa was an incredibly supportive editor and friend who humanized the publishing Lisa was an inspiring, generous, and kind business. Her kindness and warmth to both person. She was a true colleague and friend, of us made working with her a dream. We always supportive and interested. I was miss her. extremely saddened by her passing. The Summer 2010 issue of THE NEW SOCIAL Grafton H. Hull, Jr. & Jannah J. Mather WORKER magazine was dedicated to Lisa, University of Iowa who will be missed by many in the social work community. Lisa Gebo is credited, along with Marshall Smith and Bob Rivas, with starting a BPD Linda May Grobman, ACSW, LSW, institution and tradition, the Shameless Publisher/Editor, THE NEW SOCIAL Blues Band. The initial performance of the WORKER, Publisher of the Journal of SBB included Lisa, Marshall, Bob, and Jim Social Work Values and Ethics Wahlberg in San Diego in 1989. Since then, the band has performed at 39 dances and arts festivals in more than 30 cities, the most recent concert in Destin, FL in 2008. Lisa was a frequent performer with the band and was responsible for securing corporate sponsorship for the band from Cengage publishing (Brooks/Cole).

Marshall L. Smith Professor Emeritus, Rochester Institute of Technology Professor (Retired), University of Hawai‘i @ Mānoa

and

Robert Rivas

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve Letter to the Editor

Stephen,

Upon reading Editorial Comment: Sex, Sex, Sex, that's all you think about! (Fall 2009, Vol. 6, #3), I wanted to tell you that I have become very concerned that social work educators are NOT teaching students about countertransference. I believe the concept is still so important for ethical practice. I am worried that the baby has gotten thrown out with the bath water (psychoanalytic theory) and that our profession may be proceeding without benefit of that part of the conceptual foundation. I am going to try and find this book that you mention. Thanks for writing this. I am only just now reading it. Have other people responded?

Rana Duncan-Daston

Editor’s Response

Rana,

The concept of countertransference seems to be avoided in the academic world of social work. Licensing state boards are utilizing the concept. I still find it in a few textbooks. If you are still interested in Alter and Evens, I found a copy for sale at http://www.amazon.com/Evaluating-Your-Practice-Assessment- Springer/dp/0826169600/ref=sr_1_1?ie=UTF8&s=books&qid=1282011120&sr=8-1

Steve

Stephen Marson, Ph.D. Senior Editor

Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve