Bioethics and biomedical ethics are defined. Common bioethical concepts, exemplary moral values, fundamental ethical principles, general ethical theories, and approaches to moral reasoning are reviewed. The scope of topics and issues, the nature of practice situations in bioethics, and social work roles on organizational bodies that monitor and respond to bioethical issues are summarized, as are trends in bioethics. Practice contexts, from beginning to end of life, are highlighted with biopsychosocial facts, ethical questions and issues, and implications for social work—a profession uniquely positioned in giving bioethics a social context.
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Bioethics
Larry W. Foster
Article
Confidentiality and Privileged Communication
Carolyn I. Polowy, Sherri Morgan, W. Dwight Bailey, and Carol Gorenberg
Confidentiality of client communications is one of the ethical foundations of the social work profession and has become a legal obligation in most states. Many problems arise in the application of the principles of confidentiality and privilege to the professional services provided by social workers. This entry discusses the concepts of client confidentiality and privileged communications and outlines some of the applicable exceptions. While the general concept of confidentiality applies in many interactions between social workers and clients, the application of confidentiality and privilege laws are particularly key to the practice of clinical social workers in various practice settings.
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Disability: Psychiatric Disabilities
W. Patrick Sullivan
The psychosocial catastrophe that accompanies serious mental illness negatively impacts individual performance and success in all key life domains. A person-in-environment perspective, and with a traditional and inherent interest in consumer and community strengths, is well positioned to address psychiatric disabilities. This entry describes a select set of habilitation and rehabilitation services that are ideally designed to address the challenges faced by persons with mental illness. In addition, it is argued that emphasis on a recovery model serves as an important framework for developing effective interventions.
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Impaired Social Workers/Professionals
Frederic G. Reamer
The possibility of practitioner impairment exists in every profession. Stress related to employment, illness or death of family members, marital or relationship problems, financial problems, midlife crises, personal physical or mental illness, legal problems, substance abuse, and professional education can lead to impairment. This article provides an overview of the nature and extent of impairment in social work, practitioners’ coping strategies, responses to impairment, and rehabilitation options and protocols. Particular attention is paid to the problem of sexual misconduct in social workers’ relationships with clients. The author reviews relevant ethical standards and presents a model assessment and action plan for social workers who encounter an impaired colleague.
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Moral Injury in the Military
Lataya Hawkins
Moral injury has become a common term used to describe the complex symptoms experienced when there is a violation of one’s moral code. While the term is new, the concept of moral injury has been prevalent in human society since ancient times and conceivably since the beginning of humankind. It can be traced back to the Greco-Roman era when warriors shared intimate stories of their moral challenges on the battlefield. Moral injury has been extensively researched within the military population to describe the soul wound some service members carry because of war. It should not be confused with posttraumatic stress disorder (PTSD), the well-known mental health condition associated with veterans, however they can comorbidly exist with overlapping symptoms which therefore often makes it difficult to distinguish. What makes moral injury different from PTSD is that in many occurrences, it is the individual who commits a moral offense (versus mortal danger to self or others), and consequently must deal with aftermath of failing to be the moral (good) person they believed they were. Moral injury is important to understand conceptually and recognize clinically as it has been found to be closely associated with increased risk of suicide in service members and veterans.
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Post-Disaster Trauma and Recovery
Tara M. Powell, Shannondora Billiot, and Leia Y. Saltzman
Natural and man-made disasters have become much more frequent since the start of the 21st century. Disasters have numerous deleterious impacts. They disrupt individuals, families, and communities, causing displacement, food insecurity, injury, loss of livelihoods, conflict, and epidemics. The physical and mental health impact of a disaster can have extensive short- and long-term consequences. Immediately after a traumatic event, individuals may experience an array of reactions such as anxiety, depression, acute stress symptoms, shock, dissociation, allergies, injuries, or breathing problems. Given the economic and human impact of disasters, social workers are often quick to respond. Historically, the social work profession has provided services on the individual level, but initiatives have expanded to address community preparedness, response, and recovery.
This article will explore the complexities of disaster response and recovery. Health and mental health impacts will be examined. Resilience and posttraumatic growth will then be discussed, exploring how individuals overcome adversity and trauma. Individual and community level preparedness mitigation, response, and recovery will explore how the field of social work has evolved as disasters have increased. Followed by an exploration of how social work has evolved to develop individual and community level preparedness, mitigation, response, and recovery activities as disasters have increased. Finally, the article will examine special populations, including those with disabilities, children, indigenous people, older adults, and social service workers in all phases of disasters. As disasters grow more frequent it is vital for social work professionals to improve their efforts. We will conclude the chapter by examining the coordinated efforts the social work profession is involved in to help communities recover and even thrive after a traumatic event.
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Professional Impairment
Wilma Peebles-Wilkins
Practitioners who were presumed to be competent may develop difficulties that interfere with job performance. Such professionals are considered impaired and may suffer from compassion fatigue, substance abuse, mental disorders, and other forms of distress associated with daily living. Practicing while impaired is unethical and can potentially be harmful to clients. Colleague Assistance Programs from professional associations or diversion systems and legal sanctions imposed by state regulatory boards are forms of intervention strategies that are employed. Self-care strategies and consciousness-raising among professionals are the best forms of prevention.
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Quality of Care
Enola Proctor and J. Curtis McMillen
Assessing and improving the quality of social services is one of the most pressing concerns for social work practice and research. Practice in nearly every setting is affected by stakeholder expectations that agencies monitor and improve quality. This entry addresses the meaning of the phrase “quality of care” with respect to social work services, considers this topic in relation to quality improvement, quality assurance, and evaluation of services, and points to the research that is needed in order to assess and improve quality.
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Sex Trafficking Policy
Kathleen Bergquist
Human trafficking, to include labor and sex trafficking, was recognized by the United Nations in 2000 through the Convention Against Transnational Organized Crime, supplemented by the Protocol to Prevent, Suppress, and Punish Trafficking in Persons Especially Women and Children (Palermo Protocol). Nation states that ratified the protocol signaled their intent to be legally bound by it and consequently to develop policies to implement within their respective countries. The definition of human trafficking generally includes the commercial exploitation of persons for labor or sex. The International Labour Organization estimated in 2016 that of the 24.9 million people trapped in forced labor, 4.8 million are being sexually exploited. This article provides a historical context for sex trafficking, some discussion about the political evolution of sex trafficking legislation, current knowledge, and practice.
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Social Work and Coercion
Tomi Gomory and Daniel Dunleavy
Social work is perhaps most distinctive for its clear and outspoken commitment toward improving the well-being of society’s vulnerable and disadvantaged groups, while still emphasizing the importance of respecting and defending personal rights and freedoms. Though there is a fundamental necessity for coercion, or its threat, for eliciting civil social behavior in a well-functioning society, it is professionally and ethically imperative that social workers make explicit our rationales for, justifications of, and the evidence used to support or reject coercive practices in our work. Social work’s engagement with coercion inevitably entails the ethical and social policy arguments for and against its use, as shown in a review of the empirical evidence regarding its impact on the professions’ clients, exemplified by three domains: (1) child welfare, (2) mental health, and (3) addictions. Recommendations for future improvements involve balancing the potential for harm against the benefits of coercive actions.
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Suicide and Public Policy
Janelle Stanley and Sarah Strole
The historical context of suicidal behavior and public policies addressing suicide arose simultaneously within the United States, and both reflect a culture of discrimination and economic disenfranchisement. Systems of oppression including anti-Black racism, restrictive immigration policy, displacement of American Indigenous communities, religious moralism, and the capitalist economic structure perpetuate high-risk categories of suicidality. Suicidal behavior, protective factors, and risk factors, including firearms, are examined in the context of twentieth and early twenty first century public policy. Recommendations for public policy will be discussed with consideration for policies that impact communities disproportionately and social work ethics, such as right to die laws and inconsistent standards of care.
