HHS 201 Introduction to Human Services Wk2-D1
Chapter 5 Values and Ethical Dilemmas
Betty is advising a welfare recipient on how to deal with a welfare worker. The worker is required by law to ask the client where her former husband is and to give his Social Security number. Then the worker will turn over this information to the Department of Revenue, which will pursue the man aggressively for support. The welfare recipient knows where her former husband is, but is afraid to tell the worker because her husband had beaten her and she fears he would be abusive to her again. The woman asked what she should do. Betty knows it is wrong to lie to the worker, yet she also knows that it would be in the woman’s best interest to tell the worker that she doesn’t know where her former husband is. What should Betty tell the woman? What would you do?
Linda is a case worker in the child welfare department. The school guidance counselor has reported a mother for neglect of her child. The child is malnourished and listless. She cannot apply herself to her studies. Linda talked with the mother and found out that she formerly had received money from Transitional Assistance to Needy Families (TANF), but had reached that state’s two-year time limit and had been cut off from TANF. She tried to feed her child and often went hungry herself, but even with food stamps, she did not have enough money to feed the child adequately.
Linda’s supervisor advised her to place the child in foster care, but Linda knew that the agency did not have enough good foster parents and was having trouble recruiting them because so many women were working, and the agency did not pay enough to foster parents to make it worth their while to be foster parents. She could place the child in a foster home where there were already more children than the agency usually allowed, but would the child be any better off than in her own home? It would be traumatic for the child to be taken from her mother whom she loved. Yet she would probably get enough to eat in this foster home, even though the foster mother would not be able to give her the attention that she needs. What should Linda do?
Every attitude and value carries with it the seeds of conflict and insoluble dilemmas. Debates about the ethics of helping are not just mental gymnastics best left to university scholars or cloistered philosophers. Human service workers face dilemmas or value conflicts of one sort or another every day, no matter what their role in an agency.
ethics of helping
An ethical commitment to help others rather than engage in dog-eat-dog competition.
Sometimes there are conflicts between what we have been taught is correct behavior and what our clients do. For example, perhaps our parents, church, and school taught us that it is wrong for a woman to get an abortion; yet we may work with many people who do not share this value. Or perhaps, because everyone we knew said so, we might believe that most welfare recipients are lazy people avoiding work. Yet we find that assumption false when we read research on the subject. Which path do we follow when we must choose between our vision of life and our client’s, between a long-held belief and research findings?
Value conflicts are often caused by the realities of our work. We know that our ethics dictate a certain path, but the efficiency needs of the bureaucracy that employs us or provides funds and the pressure of public opinion—especially in an election year—demand actions counter to our convictions. Human service workers know that whoever pays the piper calls the tune!
5.1 Can Workers Be Completely Unbiased?
Our social class, ethnic group, or gender has shaped many of the values we hold. These values may be very different from those of people from another group. This difference can create problems in the helping relationship.
Some theoreticians urge workers to be objective and “value free,” which means being careful not to impose their own values on their clients. Yet in practice this is simply impossible. Even if one only grunts and says “uh-huh,” the timing of the noises can reflect a value judgment about which of the client’s statements warrant attention; inflections of the voice can give a sense of approval or displeasure. Inevitably there will be some differences between the client and the worker in attitudes toward politics, religion, sexuality, culture, social class, time orientation, or the environment, or in beliefs about human nature. Some of those value conflicts may not be very important. A Democrat can help a Republican, or vice versa, without needing to agree on the respective party platforms. But if the worker honestly believes that abortion is murder and the client wants help in terminating a pregnancy, that can create such a serious problem in their working relationship that special effort is required to soften or eliminate the conflict.
value conflicts
Disagreement brought about by differences in values between people.
In the following pages, we will look at some of the areas that can lead to value dilemmas and conflicts, either within us as workers or within society as a whole. Often the dilemmas or conflicts occur simply because human situations are by nature unclear and complex. The choices open to our clients are all imperfect, and each carries unknown consequences. “The horns of a dilemma” is an apt phrase. The very definition of a dilemma implies that it is an impossible situation with no solution. We shall give some case examples and ask you to think through the values and ethics involved in each example, using the questions in Figure 5.1.
value dilemmas
A situation in which competing values make it difficult, if not impossible, to determine the correct choice.
5.2 Dilemmas Surrounding the Value of Self-Determination
What happens when one person’s right to control his or her own behavior clashes with another set of rights? Self-determination is a value held in such high esteem in the social work profession that the National Association of Social Workers (NASW) code of ethics puts it at the top of its list of professional values: “The social worker should make every effort to foster maximum self-determination on the part of clients.”
self-determination
A person’s right to determine his or her own life plan without interference.
Figure 5.1
Human service dilemmas
Questions to Guide Decision Making
1. What values are promoted by the action?
2.What values are violated by the action?
3. Is the client competent to decide? If not, how should a decision be made? Who should make it? How should we define competence?
4. How does the social worker’s position/power affect our evaluation of the action? How does the institutional setting affect our evaluation?
5. What alternative actions are possible? (Evaluate each in terms of questions 1 through 4.)
6. How do your own values affect the way you evaluate the action? Would your client or agency make a different evaluation?
In evaluating each course of action, consider the client’s right to self-determination; such values as privacy, trust, honesty, and respect; the good or harm of the action for the well-being of the client/others/community.
Source: Rhodes (1989)
Lynn Atkinson, a social work professor who believes that social workers should not force their services on clients, defines self-determination as follows:
In working with people, social workers must respect the right of individuals to choose their own life paths. Although a social worker may disagree with the choices or the values of a particular person, the social worker must respect that individual’s right to believe and do as he or she wishes and honor that right by not forcing the person to do something that is against that person’s will. (Atkinson & Kunkel, 1992, pp. 159–160)
In a rejoinder to Professor Atkinson, another professor of social work, O. Dale Kunkel, points out that subsections of the code of ethics on self-determination “quickly hedge by characterizing the legal conditions under which client self-determination is not primary” (Atkinson & Kunkel, 1992). Kunkel argues that social workers often must work with clients who do not come to them of their own free will because they know they have a problem and want to solve it. Social workers must investigate complaints of child abuse and neglect with or without the client’s consent; they counsel alcoholics and drug abusers who have been court ordered into treatment; they work with juvenile delinquents and adult criminals who are incarcerated or who are on probation or parole; they treat mentally ill people who have been involuntarily committed to hospitals. Many of these people could assert that their self-determination is being abridged.
What happens to the value of self-determination when someone has or might be hurting himself or herself or others? Consider the following case reported in a local newspaper. If the judge asked you to give your professional opinion of what should be done, what would you say?
Case Example Social and Moral Issues in the Case of a 96-Year-Old Woman
Kennebunk, ME—It would be a cruel euphemism, a gross understatement, to say that Nellie Teach lives in squalor.
Neither words nor pictures can adequately capture the wretchedness in which this feisty and fiercely independent 96-year-old woman makes her home.
The kitchen resembles a dung heap. She sleeps and lives in this room; all others are barricaded by rubbish. The stench made at least one social worker ill. The three burners on her gas stove are fully ablaze to heat the room; cardboard containers sit precariously close to the flames. The floor beneath her bare feet is rotted away.
This is home to Nellie Teach, a home she has lived in for decades and which she adamantly refuses to abandon. The faded white two-story house is owned by a disabled, elderly nephew who cannot make repairs to it. “I don’t want a nice apartment,” she said last week. “I don’t want something that belongs to someone else. I don’t want people interfering with me.”
People who look in on Nellie Teach—neighbors, nurses and doctors, state social workers—fear for her life. They want to clean her house or find her new quarters. But Ms. Teach will not clean up, and she will not go. Doctors say she is mentally competent, so she cannot be removed against her will. The town, as a last resort, went to court last month. They have asked for the authority to “cleanse, disinfect and fumigate” her home.
The conflict between a community that wants to help and a woman who refuses help has opened a panoply of social, moral, and legal questions that are neither unique to Nellie Teach’s situation nor easy to answer. Officials in Kennebunk say there are other people in town just like her. Advocates for the elderly say every community in Maine has its Nellie Teaches.
Compassion seems to have dictated the actions of those who have tried to help Nellie Teach. Yet many people say the state and the town should leave her alone, that they are trying to evict a poor, hapless woman. Others say too little is being done to help her. “We’re either blamed for being intrusive or not doing enough,” says A. Ricker Hamilton, regional program manager for the Maine Department of Human Services.
“How do you intervene and still respect the rights of the individual?” asks Lee Tallion, community care director for Southern Maine Senior Citizens, Inc. “Nellie Teach has a right to do what she wants until legally she endangers herself or someone else.”
Nellie Teach is a staunchly independent woman who reached adulthood long before welfare became commonplace. The state is an institution that is feared by the Nellie Teaches of New England. It engenders distrust, even contempt.
Some people question the town’s suit, wondering whether a serious health hazard does exist. After all, her living conditions have been horrendous for years, according to neighbors and social workers. Nellie Teach is 96 and in excellent health, given her age, according to doctors who have seen her recently.
People wonder what will happen to Nellie Teach if the town should win its suit. “This lady,” says her physician, “has always found the cracks in the system to prevent anybody she doesn’t want from coming into her house and changing the status quo. I think a person’s independence is to be cherished. But there’s a line somewhere that must be drawn.” (Adapted from Berney, 1984.)
This case is a vivid illustration of the complexity involved in making ethical decisions—individual rights versus the rights of the community. When they conflict, human service workers have to decide which takes precedence. Yet in Nellie Teach’s case, officials disagreed about the danger she posed to herself or society.
On the surface, this case involved an issue of public health, but some of the unspoken issues may have involved deeper levels of anxiety about cleanliness and neatness and the moral implications of dirtiness and disorder. “Cleanliness is next to godliness” is an old saying from our Puritan heritage. Many of our ethical dilemmas come from conflicting moral standards. Sometimes the conflict is framed in terms of bureaucracy versus the individual. Bureaucrats who are removed from the life of the local community are often more likely to see issues in abstract, impersonal terms and in terms of the demands of their job. Nellie Teach’s neighbor who took her food saw no problem, whereas the director of the public health department saw a public health problem that he had to do something about.
Human service workers employed in public welfare are confronted daily with ethical dilemmas. An especially painful one was posed during the 1950s and early 1960s when, in some cities, workers were ordered to make night raids on single-parent welfare recipients to see if an unauthorized male was living in their homes (in which case the males would be responsible for their financial support). Knowing that the Supreme Court had declared this practice unconstitutional, a social worker who lived by the values of the profession was faced with the choices of quitting the job, fighting the ruling powers, or violating the ethics of the profession.
One worker who sued the department of welfare for violating the rights of clients to privacy was, in fact, fired for insubordination, but that worker’s courage eventually helped put an end to the practice.
Self-Determination and Child Abuse
Now consider a case that deals with the widespread conflict between a client’s style of parenting and an agency’s concept of what is appropriate child rearing. This case is summarized from a newspaper article.
Case Example Falsely Accused, a Mother Fights Back
Scituate, MA—The call that brought terror into Brenda Frank’s life came on September 17, 1986. A social worker with the Department of Social Services informed Frank that an anonymous complaint of sexual abuse and neglect of her two young daughters had been filed against her.
“I was frozen. Shocked. It was beyond my comprehension,” said Frank, during a recent interview in the living room of her modest two-bedroom apartment in this seaside town. “The allegations included the fact that my 4-year-old, Emily, was still being breast-fed occasionally and that both girls (Emily and Rebecca, or Becky, then 6) slept in my bed with me.”
Where did such allegations come from? Did she have an unknown enemy out there somewhere?
“I felt so vulnerable,” said Frank. “Everything you do is put under a microscope by DSS and you have to defend your every move. I stopped letting the girls sleep with me. I wouldn’t let them go outdoors to play in case they fell and got hurt. It was all so very isolating. But I didn’t know who to trust. I didn’t want anyone to see me, the lady accused of abusing her kids, riding my bike around town or walking down the street.”
When Frank received the phone call from DSS, she had been separated from her husband for five years and was a stay-at-home mother living on welfare. Although finances were always an issue, Frank said she was grateful to have two healthy children, a roof over her head in a town with good schools, nearby stores that she could reach by bicycle, new friends, and like-minded young mothers she met through La Leche League (a group advocating breastfeeding until a child naturally weans herself).
Frank describes what happened when the worker from DSS came to her home:
“I was very nervous and frightened and had my mother, a nurse, come for support,” said Frank, who had read dozens of books on nutrition, childbirth, and parenting during her two pregnancies. “But I felt sure that all I had to do was explain the La Leche philosophy of child-led weaning and give her some of their literature. I thought I would show her their literature and the stuff I’ve been reading about the concept of mother and child sharing a bed. I had a book by Tine Thevenin called The Family Bed: An Age-Old Concept in Child Rearing.
“I told the worker that I didn’t agree with the fact that in our country children are expected to sleep alone at night in their own rooms behind closed doors. I told her my girls slept with me because I wanted them to feel safe at night.”
Several days later she got a letter from DSS telling her that the allegations against her had been substantiated. It said:
“You have neglected to guide your children in age-appropriate individuation development and have exposed your children to sexual stimulation with your belief in the concept of the ‘family bed.’”
“In other words,” said Frank, “I was found guilty of the way I had chosen to parent.”
Frank believes the person who anonymously reported her to DSS worked at her complex and might have been angered by Frank’s advocacy against the use of pesticides on the grounds and for the ability of elderly residents to have pets.
Frank turned to a lawyer for help. They appealed to the commissioner of DSS for a review of her case. It was under this review that the allegations against her were dropped. But it would be 1989—two years later—before her name was finally taken off DSS’s central list as an alleged perpetrator.
Frank may have won her own battle, but she has not remained silent. She continues to testify before state legislatures, to pore over books in law libraries, and to counsel others. (Doten, 1991)
Although Frank won her case, the politics at the Department of Social Services (DSS) did not change until a well-publicized case of a child being peremptorily removed from a foster home in September 1992 created a public furor. The governor ordered the creation of a special commission to investigate DSS policies and procedures. Several bills were introduced in the legislature to create an appeals process for removing children from biological or foster parents due to Frank’s advocacy. Now there is an automatic review process in place. (Doten, 1991, p. 31)
Child-welfare agencies across the nation are under fire from groups of all ideological points of view. Many states have had lawsuits brought against them:
From conservatives objecting to the agency invading the sanctity of the family;
From advocacy groups claiming that the agency fails to protect children because it is understaffed and underfunded and does not adequately train workers;
From parents claiming that their rights have been abused by intrusive social workers;
From parents claiming that the agency doesn’t give them the services their children need;
From foster parents claiming that the agency does not treat them like co-professionals and does not give them enough help.
In May 1992, about 200 aggrieved people held a rally in the parking lot of the Division for Children and Youth Services (DCYS) in Concord, New Hampshire. They were supporting Stephen and Joan DeCosta, both born-again Christians whose four children were placed in foster care during a highly publicized dispute with the division in 1989. The DeCostas were accused of child abuse when the children’s grandmother reported that one of the DeCosta children had been spanked until he bled. The DeCostas are part of a group of parents who claim they have a right to decide how to discipline their children, while DCYS maintains it has an obligation to draw the line. “A district court judge found the DeCostas guilty of abuse, but the case was resolved by a consent decree between the family and the division. The family was reunited, which the division insists is always its ultimate goal” (Doten, 1991, p. 31).
The Frank and DeCosta cases represent very different child-rearing philosophies. The DeCostas subscribe to the biblical injunction “Spare the rod and spoil the child.” Most parents in the United States probably spank their children, but child-welfare agencies seem to be moving in the direction of regarding spanking, especially severe spanking, as child abuse. They are concerned about the rise of violence in our society, and perhaps spanking sends the wrong message to a young child. Most shelters for battered women do not allow the parents to spank their children while they live in the shelter.
Child protection workers have little guidance from state laws about what constitutes abuse. Parents in all fifty states are allowed to hit their children. There are limits to what is allowed, but out of reluctance to legislate parental conduct, state lawmakers have shied away from getting too specific about those limits, instead letting courts consider the matter case by case. A Legal Aid Society’s training guide for its lawyers who work in New York’s Family courts cites the following cases:
In one case, inflicting cuts and bruises on a child was deemed “excessive corporal punishment,” amounting to neglect, the most basic and frequently charged form of child mistreatment. But in another case, shaking a child and causing her to hit her head on the pavement was ruled allowable.
Hitting a 9-year-old with the buckle end of a purse strap for leaving his 2-year-old sister alone in a room was acceptable. Hitting a child with a belt for lying on the floor, kicking a table and peeling paint off a wall were not.
Leaving red marks on the face of a 13-month-old constituted neglect. Dragging an 11-year-old out of a car by the collar, scraping his neck, and throwing on the ground, scraping his knee, did not.
In a case where a father was charged with abuse, a more severe infraction than neglect, judges held that biting a girl on the face and arm, leaving severe bruises, did not cross the line. In this context, the threshold for abuse was intentionally causing or risking a physical injury that involved disfigurement of “protracted impairment of physical of emotional health.”
In 2008, Cesar Rodriguez was accused of murder for killing his seven-year-old stepdaughter Nixzmary. He admitted that he routinely beat Nixzmary with a belt, hit her with his hands using “all my force,” threw her on the floor, and held her head under cold water the night she died in January 2006. He admitted duct-taping her emaciated thirty-seven-pound frame to a chair and binding her with bungee cords. Mr. Rodriguez’s lawyer Jeffrey T. Schwartz argued that Mr. Rodriguez gave Nixzmary the same kind of discipline that Mr. Rodriguez’s father had given him, including hitting him a lot and holding his head under cold water. This corrected Mr. Rodriguez/s waywardness and helped him grow up to be a decent father. Mr. Schwartz said, “It was done to him, and it didn’t kill him.”
The City Council of Oakland, California, introduced a resolution in 1999 to make Oakland the nation’s first official No Spanking Zone (Gorov, 1999). They planned to place stop signs with that message in libraries and other public buildings. “We want people to know it’s not a good idea to hit kids. And when the government takes a stand against it, it helps them realize they’re not supposed to do it,” said Dr. Irwin Hyman, a psychologist who runs the National Center for the Study of Corporal Punishment and Alternatives at Philadelphia’s Temple University (Gorov, 1999).
Opponents of the purely symbolic resolution countered that local government has no business telling parents how to discipline their children, and that laws already exist to protect youngsters from child abuse. (The resolution did not pass.)
Twenty-three countries have passed bans on parental corporal punishment, including Sweden, Norway, Finland, Chile, the Netherlands, New Zealand, Spain, and Venezuela.
Genuine Child Abuse Versus False Charges
Parents of children in day care centers have been divided into warring camps over the issue of what constitutes child abuse. Day care centers have set up strict guidelines for touching children, making teachers cautious about physical contact. Parents have become more cautious about putting their children in day care centers. Ann Withorn, a professor of human services at the University of Massachusetts, believes that conservative officials consciously manipulate people’s sexual anxieties in order to discourage parents from using day care centers, thus taking the pressure off the government to provide funding for them (Withorn, 1994).
This conspiracy theory is, of course, quite controversial. False memories and false accusations occur, but so do actual cases of child abuse. Clearly, abuse must be treated as an outrageous and impermissible assault on children. At the same time, there is a great deal of hysteria about sexual abuse, and some innocent people, such as Brenda Frank, have been victimized by this hysteria.
This issue presents human service workers with the complex problem of differentiating between genuine sexual abuse and false charges. In Frank’s case, her consulting psychiatrists judged that breast-feeding children to a late age and allowing children to sleep with her did not constitute sexual abuse. When experts disagree on the issues involving parenting styles and lifestyles, there are no easy answers for human service workers.
Self-Determination When Treatment is Mandated
To regain custody of their children, some mothers have been ordered to undergo treatment for their substance abuse and counseling for their personal problems. Under these conditions, it is very possible that a client will go through the motions of mandated treatment simply to gain the promised benefits or avoid punishment. But can people change if they are forced to accept help? Consider the following case, in which a mother did what she had to get her children back but never liked what she had to do. This is an actual case, described by Robert Ingram (1992), a social work therapist and one of the founders of Empower, a welfare rights group.
mandated treatment
Treatment that is legally required by the courts or by government officials.
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Case Example Alice
“I was working in a nursing home as a nursing assistant. I didn’t want to ask welfare for anything. It felt good. I worked from 7 to 3. My 12-year-old daughter was supposed to take my 6-year-old son to nursery school and then go to school herself. They were mad because I was working so the kids didn’t go to school. They fooled around and they set the house on fire.
“They [social service department] took the kids. I was missing work, and I lost the job. They said the kids were emotionally upset. Any kid would be if he was taken out of his home. They wouldn’t let me see the kids. They told me that if I go to therapy, I’d get my kids back. They didn’t say anything about how long I’d be in therapy. They told me it would be up to the therapist to say when the kids could come home. The therapist was like a judge. [I] went to the therapist.
“All he wanted to do was talk about the past. What the … does the past have to do with it? The therapist said it was up to the judge when I’d get the kids back. The judge said it was up to the protective worker, and the worker said it was up to the therapist. It took me a year and a half to convince the therapist that I was well enough to have the kids at home. I was calmer because I had a job and had something to do with my time.”
Ingram asked her if the therapist said anything to her or gave her medicine that helped her to be calm, and she said, “No.” She went to the therapist once a month at first. Ingram asked her if it wouldn’t have been better to go more often to learn or do whatever it was to get the kids back.
[Alice said], “I don’t know. That’s the way it was set up. I used to tell him, ‘I’m doing good.’ There was nothing to talk about. It got to be boring. I told him, ‘I’m not trying to be rude, but I have better places to be.’ He’d sit there and shake his head yes. He had no suggestions at all. After a year and a half, the therapist sent a letter to the judge, suggesting that [my] younger child should be returned home and that the therapy should continue. Then I had to go twice a month, with my son. It was a pain. I had to get him out of school early. It was messing up his school work. [My] employer was concerned that I was taking time off work to go to therapy. The therapist told me I didn’t have to work but he wouldn’t help me get SSI [Supplemental Security Income]…”
[Ingram] asked her how she finally stopped seeing the therapist. She said that he resigned from his job. He tried to persuade her to continue with another therapist but he let her go when she insisted that she did not need to continue in treatment.
Ingram treats mandated clients, leaving the decision about whether to submit to the therapy up to the client, and recommends developing a contract with the client in the beginning. The contract certifies that the client is in treatment if he or she at least shows up regularly for interviews. “Once the therapist demonstrates his or her trustworthiness by adhering to the contract, the client may begin to work on the issues that attracted the attention of the mandating agency” (Ingram, 1992, p. 96).
Sometimes treatment is not mandated by an agency but is forced on a client by his or her family or friends. One drug treatment program, for example, occasionally kidnaps addicted adolescents at the parents’ request and physically forces them to remain in treatment. Some of these adolescents later thank their parents for doing it, believing that they would not have kicked the life-destroying addiction on their own. Others are still angry at their parents for violating their autonomy.
Parents of mentally ill children are often eager for their children to be hospitalized and to take psychotropic medication, even while the children resist both hospitalization and medication. In our interview with Judi Chamberlin in Chapter 2, Judi talks about how parents in the Alliance for the Mentally Ill often push for hospitalization and medication against the wishes of their children. The Mental Patients’ Liberation Front believes in complete freedom of choice. Its members develop self-help support groups and alternative treatment methods and hope they can win voluntary membership.
Some therapists advocate the use of aversive behavioral treatments that employ harsh methods of discipline as a training technique for clients who have been given up as hopeless by other agencies. A residential treatment institution for autistic children in Rhode Island came under fire in 1991 for such a treatment. The Massachusetts Office for Children filed suit against the institution, charging that it treated children cruelly with “white noise” and physical punishment. Many of the parents supported the institution, saying that the treatment helped their children control their behavior. In the course of the debate, some psychologists came forward with testimony claiming that there are more advanced and humane methods of treatment that are just as effective. However, the Office for Children lost the suit, and the institution continued this form of problematic behavior management.
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aversive behavioral treatment
A form of behavior modification based primarily on punishment rather than reward.
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Self-Determination is Undermined When Clients are Manipulated
Although it is not easy to know how to handle the ethical dilemmas of mandated treatment, at least both client and worker openly acknowledge that there is coercion in the relationship. But there is another kind of coercion that undermines self-determination. Manipulation by the worker is subtle and harder for a client to detect and to defend against. For example, before the 1960s, social workers were so convinced that unmarried mothers should give their babies up for adoption that they often subtly manipulated the clients into accepting that choice. By presenting no other options and services, unmarried mothers were geared to giving babies up for adoption. Homes for unwed mothers offered no opportunities to learn parenting skills, and no day care was provided. Unable to visualize any other path, young women, whether they had worked through the issues or not, simply agreed to give up their children even before their children were born. Often that might have been the best course of action, but manipulation violates the tenet of self-determination.
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manipulation
Attempts to influence someone’s behavior or thoughts by covert, unstated methods rather than open, explicit methods.
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In discussing the philosophical implications of manipulation, Rhodes argues that manipulation should usually be avoided and needs always to be carefully monitored. If the worker believes that coercion is necessary, it should generally be undertaken with the client’s knowledge. Otherwise, social workers may be able covertly to force actions on clients that society and clients would not allow if these actions were made explicit (Rhodes, 1989).
Rhodes argues that, because it is impossible to be ethically neutral in human service work, workers should be open with clients about their ethical commitments so that clients can make an informed choice. “How much a therapist reveals must depend upon the relationship and the client’s ability to process such information” (Rhodes, 1989, p. 120).
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informed choice
A choice that is made after a person has been given all the relevant information about the issue.
5.3 Some Current Ethical Conflicts
Conflicts Surrounding AIDS
The issues that surround AIDS are fiercely debated. Some children with AIDS have been excluded from nursery schools and public schools because of parents’ anxieties about contagion. Other school directors, principals, and parents have welcomed those children into their schools, convinced that such children are not a danger to the other children and that the youngsters need to live as normal a life as possible, despite having such a traumatic illness.
AIDS has also raised debate about whether medical personnel should be routinely tested, whether prostitutes or other prisoners with AIDS should be held in prisons for periods longer than their sentences to protect the public, whether condoms or clean hypodermic needles should be distributed, and even whether AIDS victims should be quarantined.
Many of those debates contain more heat than light. It is important for human service workers to base their thinking about AIDS on the most up-to-date medical information, which is willingly provided by local public-health agencies or AIDS action groups.
It is easy to fall into the trap of accepting simple stereotypes, such as assuming that all business corporations have the single-minded goal of making money. These folks, sorting grocery items at a free food bank, are employees of a large corporation, which encourages its workers to help their fellow citizens, on company time.
Conflicts Surrounding the Right to Die
Some conflicts between the individual and the community spring from conflicting interpretations of morality. For example, does an individual have a right to choose to die, or does the state have the right to forbid that choice? If a terminally ill person wants to die, should a doctor help her or him do so? Do parents have the right to decide on euthanasia (also called mercy killing) for their terminally ill child?
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euthanasia
Active intervention in hastening death, usually made by a doctor with the permission of the dying person or his or her family.
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The following case was reported by the Hastings Center, an organization founded in 1969 to study issues raised by the advances in medicine, the natural sciences, and the social and behavioral sciences. The Hastings Center studies “organ transplants, human experimentation, prenatal diagnosis of genetic disease, life-extending technologies, recombinant DNA research, health policy, and control of human behavior” (Hastings Center, 1979, p. 1).
Case Example Andrea
Andrea was a 9-year-old girl who had been diagnosed as having cystic fibrosis at the age of 13 months. Since then she had been hospitalized twelve times, eight times during the last year.
When admitted for the last time, she was already receiving an experimental antibiotic, which was being administered in an attempt to control a resistant pneumonia superimposed on severely damaged lungs, a result of her underlying disease. She was at that time a severely ill, emaciated child with moderately labored breathing. She seemed to have no interest in her environment and refused to communicate with anyone but her mother.
The parents indicated that in the event of a cardiac or respiratory arrest, they did not want their child to be resuscitated, and the appropriate medical order was written. The child was not involved in these conversations or subsequent decision making.
As this child’s condition continued to decline, the parents asked the doctor how much longer she would live and how she would die. At one point the father said: “Watching your own child die is worse than dying yourself.” This comment led to a discussion of active euthanasia utilizing intravenous potassium chloride or a similar drug. The physicians pointed out that no matter how hopeless a situation or how much suffering the patient and family were enduring, the law prohibits the active taking of a patient’s life. They refused to consider this option. The following day, Andrea’s heart began to fail. Her condition became progressively worse, and she died approximately forty-eight hours later. During these last two days, her parents were in great despair because of her steadily deteriorating condition. They felt helpless and impotent to alleviate their daughter’s distress. Medical treatment was continued to the end, and no measures were taken to hasten Andrea’s death.
Approximately two months after her death, the mother was asked if she would still have given permission for active euthanasia if she had been offered that option. She replied, “Yes.”
Should active euthanasia be permitted to spare the patient and family from suffering when death is inevitable? Does it make a difference if you are deciding about a child, a young adult, or an elderly person? Do you think you would think the same way if it were your relative? What if the doctors were wrong, what if a new medication were about to be discovered that could have saved Andrea’s life a few months later? How can we be sure?
In his commentary on this case, James Rachels (1979), a philosophy professor, points out that the American Medical Association (AMA) says that active euthanasia is not only illegal but immoral as well. The AMA condemns mercy killing as “contrary to the most fundamental measures of human value and worth.” However, the AMA statement goes on to say that allowing patients to die by ceasing treatment is in some circumstances all right. Rachels argued that the doctors should have given a lethal injection to end Andrea’s suffering. The doctors chose not to prolong Andrea’s life by aggressive treatment, so evidently they felt that prolonging Andrea’s life was pointless. “If it was pointless for her to endure, say, a four-day period of dying, why should we choose a course that requires her to endure a two-day period of dying?” (Rachels, 1979, p. 19).
Another philosophy professor, Philippa Foot (1979), disagreed with Rachels. She thought that active euthanasia was risky in this case because of Andrea’s inability to decide for herself. She believes that “we are apt to think about [active euthanasia] in a confused and superficial way. This is one reason why there is so much danger in supporting any kind of active euthanasia, never mind its extension to children and noncompetent adults” (Foot, 1979, p. 20).
Since the Nazi death camps, decisions about euthanasia have taken on an ominous cast. No one can afford to be casual about taking human life for any reason or under any circumstances. Dangers lurk behind what seems to be an otherwise logical and compassionate policy. We don’t honestly know how we would decide the case of Andrea, but we can understand the reasoning of all the people involved.*
*The commentaries on the case of Andrea and others in the Hastings Center Report are more complex than our brief summary indicates. We suggest that it would be worthwhile for students to read some of this material at length, as the discussions give an excellent frame of reference for thinking through ethical issues. The address of the Hastings Center Report is 21 Malcolm Gordon Road, Garrison, NY 10524-4125. E-mail: [email protected].
Conflicts Surrounding Reproductive Choice
Fierce battles have raged over the issue of abortion for nearly four decades. In this deeply personal and intimate area, most people have firm opinions. Because social science is never value free, we should state our biases on this hotly contested issue. Along with most other feminists, we believe that women should have the right to choose whether to have a baby, a right that the Supreme Court affirmed in its 1973 Roe v. Wade decision.
This decision protects a woman’s right to privacy regarding what she does with her own body through the second trimester of pregnancy. Both the decision and the right have been contested ever since. The pro-choice faction fights to retain the right to an abortion for all women. The anti-abortion faction works to make it illegal in the same way that murder is outlawed.
The Roe v. Wade decision was modified in July 1992 in the case Planned Parenthood v. Casey. This case involved a Pennsylvania law that required physicians to give counseling that encouraged childbirth to women seeking abortions. After the counseling, women would be required to wait twenty-four hours before undergoing an abortion. The law also required that the woman’s spouse be notified, as well as the parents of a minor teenager.
The Supreme Court upheld all the Pennsylvania requirements except spousal notification. A narrow five-judge majority held spousal notification to be unconstitutional because it was “unduly burdensome,” particularly to women in abusive or otherwise dysfunctional marriages. It did not, however, consider a twenty-four-hour wait to be unduly burdensome to poor women. Many women cannot afford the extra travel, lodging, and child care costs they would need for an abortion. For these women, such extra costs can turn a burden into a veritable ban on access to abortion. The Hyde Amendment passed by Congress in 1976, which banned using publicly funded Medicaid money for abortion unless a woman’s life was in danger, had already limited access to abortion for poor women. Many states stopped funding “medically unnecessary” abortions. Poor women could not afford abortions. In October 1977 Rosie Jiminez, a Texas woman, died from an illegal abortion in Mexico after Texas stopped funding Medicaid abortions.
There is a fierce debate today about sex education, with the government advocating “abstinence only” programs and others arguing that young people should be told about all the options. This cartoon suggests that any sex education program given in school will not be relevant to students actual life experiences.
Other Supreme Court decisions have weakened the Roe v. Wade decision. Several states have passed laws restricting abortion in various ways. Restrictions include requiring waiting periods, informed consent, and parental notification and allowing abortion only in cases of rape, incest, and risk to a woman’s health. Many of these restrictions are now being contested in the courts. In March 1993, the Supreme Court upheld a lower-court decision that prohibited Louisiana from virtually outlawing abortions. This affirmed that states have no constitutional right to outlaw abortions. A Colorado law that prohibited Medicaid funding for abortions in cases of rape or incest was struck down by the Supreme Court in 1995, leaving intact a federal law that forces states to provide Medicaid funding of abortions for victims of rape or incest.
Anti-abortion activists have succeeded in intimidating doctors and clinics through the use of militant, often frightening demonstrations. Doctors and other clinic workers have been murdered. Most doctors now do not want to risk doing abortions. In 2010, there was no known abortion provider in 87 percent of the counties in the United States, where a third of women live (Bazelon, E., 2010).
In 1973, hospitals made up 80 percent of abortion facilities. After the Roe v. Wade decision, mainstream medicine backed away from abortions because of anti-abortion agitation. Feminist activists stepped in to set up stand-alone clinics to provide abortions. Fifteen years later, 90 percent of abortions were performed in such clinics (Bazelon, 2010). At the same time, medical schools increasingly refused to make abortion training part of their curriculum (Our Bodies Ourselves, 2010). However, an abortion-rights campaign, led by physicians themselves, has resulted in more medical schools training doctors to perform abortions. Jody Steinauer, an OB-GYN professor at the University of California at San Francisco, began the campaign in 1992. She organized the group Medical Students for Choice, which now has 10,000 members. The Accreditation Council for Graduate Medical Education—which represents the medical establishment—decided, for the first time, to make abortion training a requirement for all OB-GYN residency programs seeking its accreditation. This was opposed by anti-abortion advocates and, the following year, Congress passed the Coats Amendment, which declared that any residency program that failed to obey the Accreditation Council’s mandate could still be deemed accredited by the federal government. Today, about half of the more than 200 OB-GYN residency programs integrate abortion into their residents’ regular rotations. Another 40 percent of them offer only elective training.
People who oppose abortion made a further assault on the right to abortion through their efforts to ban what they called partial-birth abortion, a term that doctors considered medically meaningless. This ban, passed by Congress and signed into law by George W. Bush in 2003, was declared unconstitutional by Federal District Court Judge Phyllis J. Hamilton in 2004. Judge Hamilton said that the act creates a risk of criminal liability during virtually all abortions performed after the first trimester.
Writing for the National Organization for Women, Michele Keller said:
Judge Hamilton noted that the Bush Administration passed extreme legislation with complete disregard for women’s health and the law. The law would have barred safe abortions as early as 13 weeks by prohibiting a medical procedure regarded as the most effective in preserving a woman’s health and future fertility. (Keller, 2005)
Another hotly contested issue in the abortion fight was mifepristone (formerly known as RU 486), the drug regimen that terminates pregnancy within the first five weeks, which can be taken by women at home. Anti-abortion forces tried to prohibit it; pro-abortion forces fought to have it legalized. After much research, the Food and Drug Administration (FDA) finally approved it in 2000. During his 2000 campaign, George W. Bush pledged to sign any legislation that restricts mifepristone. In August 2002, anti-abortion groups petitioned the FDA to ban mifepristone. However, it continues to be sold legally.
The “morning-after pill,” called “Plan B,” has also been a hotly contested issue, even though pro-abortion forces insist that it is not an abortion because it prevents the fertilized egg from being implanted in the wall of the uterus. In August 2006 the FDA ruled that it could be sold over the counter to women 18 and older. Plan B lowers the risk of pregnancy when started within 120 hours of unprotected intercourse.
Whether or not abortions are legal, women will continue to get them. One researcher says that the real public policy question is not whether we will have abortions but what kind of abortions we will have (Miller, 1992).
The kind of abortions performed while they were illegal was often very dangerous. In his 1955 survey of female sexual behavior, Kinsey, A., Pomeroy, W., and Martin, C. (1948) reported that 22 percent of his married respondents said they had had at least one abortion. Kinsey claimed that illegal abortion in the 1960s was estimated to be the third largest moneymaker for organized crime, exceeded only by narcotics and gambling, and he pointed out that most large public hospitals had septic abortion wards to treat the large number of life-threatening infections from abortions performed under nonsterile conditions.
Anti-abortionists won another victory in 2010 when the Obama administration denied abortion coverage for women whose pre-existing conditions will place them in “high risk pools” that were established through the recent health care reform legislation. Cecile Richards, president of the Planned Parenthood Federation of America, stated:
The very women who need to purchase private health insurance in the new high-risk pools are likely to be more vulnerable to medically complicated pregnancies. It is truly harmful to these women that the administration may impose limits on how they use their own private dollars, limiting their health care options at a time when they need them most. This decision has no basis in the law and flies in the face of the intent of high-risk pools that were meant to meet the medical needs of some of the most vulnerable women in this country. (Our Bodies Ourselves, 2010)
The Fetal Protection Movement
A recent tactic of the anti-abortion movement has been the campaign to protect the fetus from harm. Anti-abortion activists claim to care only about the health of the fetus, but as columnist Bob Herbert (1998) pointed out, they have a hidden agenda, to define the fetus as a person. If a fetus were defined as a person, abortion would logically become, under the law, murder (p. 17).
In 1998 Governor Tommy Thompson of Wisconsin signed into law a bill that permits the state to take into custody pregnant women who exhibit a serious and habitual “lack of self-control” in the use of alcohol or drugs. The bill defines unborn child as a human being from the time of fertilization to the time of birth and gives the state the right to appoint a legal guardian to represent the interests of the fetus.
The fetal protection movement has not made any serious effort to provide women with the treatment they need for alcohol and drug abuse—or even adequate prenatal care. That is not part of its agenda. “When South Carolina began locking up pregnant addicts for criminal child abuse, there was no residential treatment for pregnant addicts in the entire state. Wisconsin still has long waiting lists of pregnant women seeking addiction services” (Herbert, 1998, p. 17).
Anti-abortionists succeeded in getting a law passed declaring it a crime to harm a fetus, called The Unborn Victims of Violence Act. It was passed by Congress and signed into law by George W. Bush in 2004. This law gives a fetus the same rights as the pregnant woman. Kim Gandy made the following observations on the law:
The sponsors of this cynical bill have devised a strategy to redefine the Fourteenth Amendment, which guarantees equal protection of the law to “persons,” which has never been defined to include fetuses. The inventive language of this bill covers “a member of the species homo sapiens at any stage of development.” Such a definition of “person” could entitle fertilized eggs, embryos and fetuses to legal rights—ultimately setting the stage to legally reverse Roe v. Wade. (National Organization for Women, 2004a)
Crack Babies
It is hard to be clear about our values when we are bombarded by the agendas of so many different individuals, organizations, and the media. Newspapers want to sell papers, and TV shows want to get a large audience, and they often sensationalize stories in order to do this. The crack baby story is a good example.
The development of crack significantly reduced the price of cocaine and increased the availability of the drug, expanding its use from the middle and upper classes to urban minorities. Once cocaine abuse became crack abuse, the problem became sociopolitical rather than strictly medical (Musto, 1988). The rate of substance abuse among black women and among white women was about the same, according to a study of pregnant women in Pinellas County, Florida, although black women used cocaine more often than white women. However, despite similar rates of substance abuse, black women were ten times more likely to be reported to the authorities (Chasnoff, 1989). For the media, the demonization of drug-abusing parturient women made better copy than did detailed elaborations of the complexity of the germane issues (Lyons & Rittner, 1998).
The issue of decriminalization of marijuana, especially for medical purposes, is very controversial. Advocates and opponents of making the growing, sale, and possession of “pot” legal, give strong arguments to support their positions.
It is true that using substances such as crack, alcohol, cigarettes, and amphetamines can be harmful to a developing fetus. Yet the media seized on the issue of crack babies and created an atmosphere of hysteria with news about a problem of “epidemic” proportions. It exaggerated the numbers involved.
It is difficult to assess the causes of damage to a newborn. If the mother used any cocaine, the assumption is often made that all the damage to the child was due to cocaine when in fact there may have been multiple causes, including malnutrition. Most of the mothers are poor, and some are homeless. One researcher asks, “What would be the public implications if … we learned that what we thought were drug effects were actually due to poverty and not to drugs per se?” (Lester & Tronick, 1994, p. 118).
The media created the impression that any baby whose mother had used crack was ruined for life. Yet research suggests that the damage done to the newborn may not necessarily be permanent. Many babies can recover from the effects of crack-cocaine if given adequate treatment and support. The permanent damage some of them suffer may be the result of the family’s poverty and lack of adequate health care, housing, and other social supports.
Some of the findings of this research have begun to find their way into the popular media, but the earlier scare stories had a profound effect on politicians and officials. Record numbers of single mothers are in prison for first-time drug offenses. A 2005 report by the American Civil Liberties Union (ACLU) said:
The rate of imprisonment of women for drug crimes has far outpaced that of men, particularly women of color and low-income women. Women of color use drugs at a rate equal to or lower than white women, yet are far more likely to be affected by current drug laws and policies. Selective testing of pregnant women of color for dug use as well as heightened surveillance of poor mothers of color in the context of policing child abuse and neglect exacerbate these racial disparities. (American Civil Liberties Union, 2005)
Women who are mothers find treatment difficult to access because many residential treatment programs make no provision for the children. Pregnant or parenting women are penalized for the alleged risk to their fetuses or children posed by their drug use or addiction, rather than being given the support necessary to appropriately address their situation. In the absence of viable drug treatment options, women’s drug use and addiction are more likely to be treated as criminal justice issues than the health problems they truly are. (p. 2)
Sexual violence at the hands of correctional officers as well as the severe inadequacy of medical care are but two of the conditions faced by women on the inside. A mother’s prolonged incarceration often leads to the destruction of relationships with her family, financial hardship to the caretakers of the children left behind and, all to often, placement of children in an already overburdened and problematic foster care system, which can result in termination of her parental rights. Elders are left without caregivers, and communities without workers (p. 3).
As a result of the so-called war on drugs and promotion of “fetal rights,” women’s reproductible rights have been attacked through the criminal prosecution of pregnant women who use drugs. An estimated 200 women in more than thirty states have been prosecuted in charges of “drug delivery, “drug possession,” or “fetal/child abuse” based on evidence of drug use during pregnancy (ACLU, p. 15).
As we sort out our values, we need to be careful not to be swept up in popular hysteria about a problem, and we need to distill the true facts from all the myths and stereotypes.
Attitudes Toward Abortion are Deeply Rooted Beliefs
When does life begin? This is an abstract philosophical question, which most of us probably answer according to our value system and not by scientific evidence. Catholic theology holds that life begins at conception, although some believe that the Catholic hierarchy does not represent the views of most American Catholics on this issue nor the practice of Catholic women who have abortions at the same rate as the national average for all women. Some orthodox Jews believe that life begins with the sperm, even before it meets the egg. Other religious groups, such as the Mormons and fundamentalist Christians, oppose abortion on religious grounds.
Many of the most militant anti-abortion demonstrators have come from the ranks of fundamentalist Christians with conservative politics. Although they sponsor a few social service agencies geared to help women keep their babies, as a group they pay little attention to the policies that make it easier for poor women to raise children—adequate TANF grants, affordable housing, good wages, child care, and so forth. One of the authors of this text (Mandell) circulated a petition to raise AFDC grants at an anti-abortion demonstration. No anti-abortion protestors signed it, and some expressed their opposition to or ignorance of welfare. Many pro-choice counter-demonstrators, on the other hand, eagerly signed the petition.
Despite our own pro-choice stance, we have great respect for those who oppose abortion because of their deep commitment to preserve life and who express that commitment after the children are born by working for a more equal distribution of tax money and an end to war. The Catholic Workers are one such group of dedicated pacifists and social activists who oppose abortion.
Human service workers need to inform themselves thoroughly about the issues, be as clear as possible about where they stand, and make their position known to clients so that their biases do not subtly influence clients to make choices they may later regret.
Stem Cell Research
If a fetus deserves the same protection as an existing child, does a stem cell also deserve that protection? Is using embryonic stem cells for research equivalent to an abortion? This is the subject of fierce debate between pro-abortion and anti-abortion forces.
Embryonic stem cells, harvested from five-day-old fertilized eggs, may offer the best hope for curing some serious diseases, such as Alzheimer’s, Parkinson’s, type 1 diabetes, and arthritis. Scientists believe that embryonic stem cells can be regenerated into customized replacement organs that resist rejection. Research suggests that these cells can become insulin-producing cells that would ease the burden of diabetes (Rosen, 2001).
Federal research guidelines allow only the use of excess embryos stored at fertility clinics, a by-product of the widely accepted practice of in vitro fertilization, and then only with permission of the parents who produced the embryos (Rosen, 2001). Although the issue has been framed as an abortion issue, even the opponents of abortion are split on this. Senator Orrin Hatch, an anti-abortion stalwart, was open to the possibility of stem cell research, defending his position by arguing that people who are pro-life are also pro-life for existing life.
President George W. Bush, who had received a good deal of support from opponents of abortion, agonized over the decision, and in the summer of 2001, he compromised by allowing research on what he described as sixty self-sustaining colonies of embryonic stem cells that existed in the United States and abroad. Researchers objected that there were far fewer than sixty but seemed to accept President Bush’s decision as better than nothing. However, researchers expressed doubts about the usefulness of the existing colonies, which used material from mouse cells and bovine serum. Critics of Bush’s policy say this contaminates the colonies. This is a good illustration of how ideological positions can affect the direction of scientific research.
In September 2009, President Obama issued an executive order that expanded embryonic stem cell research. However, a federal district judge blocked the executive order, saying it violated a ban on federal money being used to destroy embryos. The ruling came as a shock to scientists at the National Institute of Health and at universities across the country, which had viewed the Obama administration’s new policy and the grants provided under it as settled law (Harris, 2010).
Sex Offenders
How do you prevent sex offenders from molesting children? Pass a law to prevent them from getting near children? After the murder of seven-year-old Megan Kanka by a released sex offender living on her street, public outcry created a call for programs to provide the public with information regarding released sex offenders. Congress passed a law in 1996 called “Megan’s Law,” which requires all states to conduct community notification but does not set out specific forms and methods, other than requiring the creation of Internet sites containing state sex-offender information. Beyond that requirement, states are given broad discretion in creating their own policies. The law was an amendment to a previous law passed in 1994, which required convicted sex offenders to register their addresses with local law enforcement (National Center for Missing & Exploited Children, 2007).
At least thirty states and thousands of municipalities nationwide have passed residency restrictions for sex offenders (Ward, 2008) and have designated areas where sex offenders are not allowed to live—near schools, playgrounds, day care centers, and other places where children congregate—in the hope of preventing repeat offenses. Does it work? There is increasing evidence that it doesn’t. Studies have shown that family members or acquaintances perpetrate most sexual molestation of children, that many sex crimes are never reported, and that sex offenders often molest beyond the areas where they live. Some scholars believe that the measures could put children in greater danger, not less—because the sex offenders go underground, because therapy works to prevent re-offense, and because limited resources are wasted enforcing the laws. No one who has professional experience in the management of sex offenders thinks these laws make much sense.
Many people ignore or minimize the issue of the civil liberties of the sex offender, believing that he poses such a great danger that his civil liberties are not important. However, the residency laws pose serious civil liberties concerns. These measures apply to convicts after they have been punished and released and served their parole. In many cases, homeowners are exempt while renters may be required to move. And this type of post-release regulation doesn’t exist for other criminal classes. For example, arsonists are not prohibited from living near gas stations. In some cases, the strict residency restrictions have caused more issues than they have solved. Many sex offenders cannot find housing in urban areas and often are forced into homelessness (Dunlap, 2010).
One of the nation’s most aggressive attempts to limit the mobility of sex offenders was struck down in Georgia in 2007 by the Georgia Supreme Court, which declared the state law unconstitutional. The Georgia Supreme Court ruled that, by forcing a sex-offender from his home, the law violated his Fifth Amendment right to be safe from the government “taking” his property. The ruling said, “It is apparent that there is no place in Georgia where a registered sex offender can live without continually being at risk of being ejected” (Whoriskey, 2007). (We discuss this case more fully in Chapter 14.)
5.4 Conflicting Views on the Nature of Human Nature
The Declaration of Independence states that people have an inalienable right to life, liberty, and the pursuit of happiness. But in daily life, no one is guaranteed a job, and no one is guaranteed an income or a home or food. No matter how compassionate a worker in a welfare department is, he or she is forced to convey the message to clients that society does not place them in high enough esteem for even a poverty-level income.
Although welfare recipients’ taxes have already paid for some of the money they receive, taxes probably do not cover all of the money received. Money must come from the haves to help the have-nots. This is also true of Social Security. Most people get back a good deal more than they paid into the fund. Yet the crucial question is not whether people should get back only as much as they paid but whether society as a whole has a responsibility to care for its members when they are having a hard time.
Your values about the kind of society you want to live in are partially shaped by your beliefs about human nature. Each of us has a mental picture of the “normal” child or adult, even if we have never articulated it. If we are program planners, administrators, or food stamp clerks, our basic view of people will be expressed in many direct and subtle ways as we plan or implement social programs.
There are arguments for and against the New York City health department’s campaign to distribute more than 1 million free condoms. Advocates argue that using condoms will reduce the spread of AIDS. Opponents assert that easy availability of condoms could increase sexual promiscuity, increasing transmission of the virus. What do you think?
These are some of the most common views of the nature of human nature. Which ones come closest to yours? In what ways do your views differ from your parents’, your peers’, or your neighbors’?
The Belief that People Need to be Civilized
Some people believe that human beings are born basically evil—born in sin. Although they may be redeemed by the grace of God, they must be kept under control by the rules and regulations of society and civilization.
For Thomas Hobbes, a seventeenth-century English philosopher, the human condition was characterized by both desire and rationality. If everyone pursued desire fulfillment, that, according to Hobbes, might lead to conflict with others and to lives that are “nasty, brutish, and short.” But every rational person wants to live and to live in peace. Thus he or she accepts authority to regulate, and perhaps curb, desire. Considering the times in which he lived, a period of constant war, Hobbes’s conclusions are understandable.
Hobbes, Thomas
A seventeenth-century philosopher who believed that people need a strong authority in order to regulate their desires.
Some people have interpreted William Golding’s widely read novel Lord of the Flies (1959) as a Hobbesian allegory. In this story, a group of English schoolboys, stranded by an airplane crash on a desert island, create a social order that looks very much like the Hobbesian scenario of dog-eat-dog survival, with restraints of authority removed. (Others point out that the boys were simply duplicating the authoritarian society of the supposedly civilized English private school from which they came.)
People who subscribe to a view of human nature similar to Hobbes’s are likely to advocate a strong authority and favor “law and order” approaches to human problems. Clearly, Hobbes doesn’t believe in self-regulation. A social worker sharing Hobbes’s distrust of self-regulation might give clients vouchers rather than cash, keep careful watch over their behavior, and invoke strong punishment for deviations.
The Belief that People are Basically Rational
While Hobbes was propounding his theories, John Locke, another English philosopher and scientist, had a different view. He believed that if people followed their own self-interest, a rational, just society would result. Locke rejected the traditional view that babies were born with fixed selfish ideas or brutish characteristics. He believed instead that a child came into the world with a tabula rasa (blank tablet) on which the world could inscribe itself through the experience of the five senses. People in the helping professions who follow a philosophy similar to Locke’s would be likely to subscribe to a more environmentally oriented psychology such as that of the behaviorist B. F. Skinner (1974). The assumption in his work is that with the appropriate stimuli, correctly administered, human social behavior can be positively shaped and changed.
Locke, John
A seventeenth-century English philosopher and scientist who believed that if people followed their own self-interest, a rational, just society would result.
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behaviorist
A theorist who believes that behavior can be shaped or changed by the systematic application of rewards for behavioral compliance with the demands of the caregiver or therapist.
The Belief that People are Corrupted by Society
Jean-Jacques Rousseau, an eighteenth-century Swiss-French philosopher, put forth the idea that people were good by nature but corrupted by civilization: “Man is born free, but is everywhere in chains.” He believed that education should draw out the knowledge that people are born with, in contrast to the “banking” theory of education, which holds that knowledge should be deposited in people’s empty heads. Education, according to Rousseau, should allow the free development of human potential. Paolo Freire (1970), a Brazilian adult educator, subscribed to a theory of education called “conscientization,” which is similar to Rousseau’s theory. According to Freire, poor people’s education should begin by raising questions about their life situation, why they are so poor, and why they have been kept from getting the education they need.
Rousseau, Jean-Jacques
An eighteenth-century Swiss-French philosopher who believed that people were good by nature but corrupted by civilization.
The Belief that People Need to be Connected to Each Other
Several nontraditional and feminist psychologists suggest that, in contrast to the individualistic and competitive orientation commonly found in men, women are socialized to place value on nurturing, cooperation, and nonviolence. Carol Gilligan (1982) asserts that women choose their actions when faced with a moral dilemma according to what effect their choice will have on the others who are involved rather than by referring to abstract concepts of justice. Caring and responsibility for others are central to their moral concerns.
Psychologist Jean Baker Miller (1976) says that these “feminine” traits that have been traditionally regarded as weaknesses are, in fact, strengths. They take us beyond the “macho” succeed-at-any-cost attitude. She suggests that men as well as women need to strengthen their ability to empower each other without needing to dominate or control.
Not everyone agrees that women are naturally more caring than men. We all probably know selfish women who don’t care about other people’s feelings, and men who are very caring. As many feminists warn, we should avoid “essentialist” thinking, which believes that women and men have essentially different and unchanging characteristics.
5.5 Conflicts Caused by Bureaucratic Demands
Most human service workers, unless they are in private practice or a small independent agency, are employed by bureaucracies that have organizational needs that may be contrary to the needs of workers and clients. In fact, they often pit workers against clients. A welfare worker, for example, may be convinced that a TANF claimant needs more money than the grant allows but is unable to help the client because of state and federal regulations.
According to Max Weber (Gerth & Mills, 1958), a nineteenth-century sociologist, bureaucracy is supposed to make work more efficient, to substitute dependable rules for arbitrary decisions, to treat people more fairly, and to judge workers on merit rather than favoritism. But bureaucracies also depersonalize and objectify people. They divide work into specialized components so that no one has the satisfaction of seeing a job through to completion. They set up hierarchies of authority that take away the autonomy of workers. One of the most pervasive problems of modern society is bureaucratization of work and of relationships. In human service work, this is especially serious because our work requires warm and genuine relationships between people.
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bureaucratization
Increased organizational centralization, hierarchical control, larger workplaces, and decreased autonomy for workers
The occupational hazard for workers in a bureaucracy is the tendency to “go along to get along.” Most workers want to keep their jobs and do what is required, even when it is not in the best interest of clients. Social psychologists have studied the tendency to go along willingly with authority. One of the most famous of these studies is the Milgram experiment on blind obedience, which explored the conditions under which people would refuse to obey immoral commands (Milgram, 1974). Milgram asked people to “shock” subjects with varying amounts of “electricity” each time they made an error on a task. (Subjects were not actually shocked but were trained actors who simulated being shocked.) Far more people obeyed the commands than either Milgram or others predicted. Milgram concluded that a person’s conscience is diminished in a hierarchical system and that in authority systems, people are more likely to see themselves as agents who carry out other people’s wishes rather than as autonomous decision makers.
Another classic study that revealed people’s willingness to go along with authority was the prison experiment that Zimbardo, Haney, Banks, and Jaffe (1982) conducted with healthy college students. Half of the students were instructed to be “prisoners,” the other half “guards.” In a very short time, the students were adopting the behavior they had been assigned. The experiment had to be discontinued because of the sadism of some of the “guards” and because some participants, especially the “prisoners,” were breaking down emotionally.
Guidelines for Dealing with Conflicts in a Bureaucracy
The task of debureaucratizing society is an enormous one that requires the best creative thoughts and efforts of all of us. We need to accept responsibility for the ethical and political dimensions of our work. Rhodes (1989) suggests that workers can do that by:
Speaking out about their beliefs, showing the politics behind alternative courses of action, and pointing out inconsistencies in the way the agency does its work. Speaking out is a skill that requires as much planning and thought as the most carefully planned case presentation.
Forming alliances with other workers and with clients to organize social action on policy issues.
Questioning the rationale behind rules and regulations rather than docilely implementing policies with which the workers disagree.
Offering expertise on legislative committees, pushing for legislative action, and educating the public about human service issues (pp. 154, 156).
The Client as Our Employer
The concept that the client is our employer is closely related to the value of self-determination—the belief that only clients can decide what is best for themselves. Even when the client does not pay a fee for our service, we subscribe to the belief that the service should be responsive primarily to his or her needs, not to the workers’ or agency’s needs. Yet clients are rarely asked to evaluate our services, make suggestions for improvement, serve on boards, or attend case conferences. Overworked agencies are under pressure to “process” people through the system in as short a time as possible.
Some workers who have undergone long and arduous training in the profession may not understand why their clients’ opinions about what they need should be valued. This is especially true when their clients are poor, incarcerated, or mentally unstable. Nevertheless, just as in a relationship with an architect, a real estate agent, or a lawyer, the client has the right to decide which problems are most pressing and which treatment methods are most acceptable.
Professionalization creates built-in conflicts about how to behave with clients. Social work comes out of a nineteenth-century paternalistic tradition. Gratitude was expected from “deserving” clients. Help was refused to the “undeserving.” Although twentieth-century professionals no longer hold such expectations, old attitudes linger. When money or services are defined as everybody’s right, as with Social Security, beneficiaries feel entitled to the benefit and do not feel any obligation to be grateful or behave in a certain way. However, when a service is not presented as an automatic entitlement, there are ambiguous behavioral expectations. Both the giver and the recipient resent a relationship in which one person does all the giving and the other does all the taking. Self-help groups derive much of their attraction from the fact that power is shared equally among the members. The relationship of a human service worker to a client is inherently unequal because of the power differential. The worker is in a position to give or withhold benefits.
In the chapter on diversity, we suggest that some cultural groups expect a very personalized helping relationship, and therefore it is important to structure the relationship to meet their expectations. A classic study of helping relationships in child abuse and neglect (Berkeley Planning Associates, 1978) concluded that two of the most important factors in helping parents were a more friendly, personalized relationship and the down-to-earth assistance given by parent aides. This was true for a wide variety of cultural groups. Rhodes (1989) concluded, after reviewing four studies of client satisfaction, that
Client satisfaction and client change depended to some extent on clients’ perceptions of their workers as “friends.” And such friendship had the following qualities: empathy, caring, flexibility, patience, suggestions rather than advice, reciprocity in the form of sharing aspects of one’s personal life, and immediate concrete help in the mode requested. In addition, many small social activities were viewed as important to befriending: “calling in for a cup of tea, accepting an invitation to a party, sending cards while on holiday, extending a home-visit to play with the children…” (p. 164)
These clients did not seem to make a sharp distinction between “friend” and “professional” when they liked their worker. If a worker was only a professional and not a friend, the worker was usually viewed with hostility or at least distrust (Rhodes, 1989).*
*Studies that Rhodes reviewed included Mayer and Timms (1970), Sainsbury (1974), Rees (1979), and Keefe and Maypole (1983).
Studies of clients’ opinion of human service workers are rare, and the few that Rhodes cited are not necessarily the last word on professional practice. Some of the findings, such as the importance of “many small social activities,” are contrary to much of the advice that the professional literature gives caseworkers.
We would understand much more about client satisfaction if every agency regularly asked for feedback. The fact that this is done so rarely suggests that professionals have not yet fully accepted clients as their employers, whom they are obliged to satisfy.
Social Class Differences between Workers and Clients
Human service workers are often of a different social class than their clients. A large proportion of agency clientele are poor, and the social class of workers generally ranges from lower to upper middle class. Sometimes workers impose their class-based values on their poorer clients. This was evident in one study of adoption workers. It showed that middle-class workers selected adoptive parents who were “shockingly similar” to themselves (Maas & Engler, 1959, p. 374). The typical husband and wife were white and Protestant, had strong inner controls and little personal flexibility, placed a heavy emphasis on education and ambition, were task oriented, lived in a single-family home, earned much more than the average income, and had at least a high school degree. Yet there are surely other kinds of people who can be excellent parents.
In the 1960s, some research showed that caseworkers believed that people should not rely too heavily on their relatives for help (Leichter & Mitchell, 1967). Caseworkers at that time were mostly white, upwardly mobile, and middle class. They tended to discourage dependence on extended-kin networks. Their attitude has changed somewhat because later research showed that networks play a major role in the lives of poor and working-class families. In fact, we have come to realize that these networks constitute a source of strength for all families. Yet, despite agencies’ professed goal of strengthening the family, the bulk of state child-welfare money is spent on foster care rather than on homemaker service, respite care, parent aides, and day care for hard-pressed families. All of these could strengthen a crumbling family, so that the child would not have to be placed in a foster home with strangers.
5.6 Conflicts Due to the Variation in National Values in the United States
Although it is as hard to generalize about national values as about individual or ethnic-group values, some dominant themes stand out in each nation. At times these themes conflict with one another. In the United States, the democratic and humanitarian values expressed in our Constitution stand side by side with the Protestant ethic, which says that all people who work hard enough can “pull themselves up by their own bootstraps.” Social Darwinism maintains that in society, as in the jungle, only the most fit can and should survive.
These contradictions help us understand the mixture of progressive and surprisingly punitive legislation that makes up our social welfare system. The values implicit in the punitive legislation often strongly influence public opinion and misconceptions about welfare assistance. In the United States, people in need of financial assistance often receive less help and are more stigmatized than they are in several European countries.
It is interesting to see how these values of competition, individualism, and a belief that people are in control of their own destiny affect the view of people in the United States toward the mentally ill. Anthropological studies of cultural attitudes toward mental illness show that many other cultures are more tolerant of mental illness than the United States and other Western societies. Schizophrenics actually seem more likely to recover in less-developed countries, such as Mexico or India (Bass, 1992).
Anthropologist Janis Jenkins found that Mexican and Indian families are more likely to believe there are forces outside each person’s control that influence their ability to ward off disease. They are, therefore, much more likely to believe that the person suffering from mental illness deserves sympathy, support, and special treatment. Latinos are also more likely than European Americans to believe that even severe mental illness is curable. When people believe that they will be cured, they are more likely to be cured. In the United States, on the other hand, we are more likely to stigmatize mentally ill people because of the dominant belief that people are autonomous and in control of their own destiny (Bass, 1992).
Jenkins (1981) found that Latino families seem to be more tolerant of unusual behavior, such as hearing voices or having delusions of grandeur, because of the way Hispanic cultures view religion. Jenkins speculated that in the Latino culture, people often talk to Jesus and the saints and feel close to spirits, so family members are not as concerned about a patient hearing voices as they are by disruptive or disrespectful behavior (Jenkins, 1981).
In contrast to the greater tolerance of Latino cultures toward mental illness, European American adults are more likely to see mental illness as a personal weakness.
Age and Aging
Increasing awareness of race and sex discrimination has been followed by an increased awareness of age discrimination. Robert Butler (1975), former director of the National Institute of Aging, coined the term ageism. In a culture that values youth, attractiveness, productivity, and activity, older people are often devalued. Professionals who work with them sometimes share society’s dominant attitudes. Many professional psychiatrists feel inadequate treating older people (Cyrus-Lutz & Gaitz, 1972). Some human service workers have misconceptions about the inevitability of the degenerative process. Although there is no evidence suggesting there must always be a decline in the mental activity, responsibility, and even sexual prowess of the elderly, it is difficult not to be influenced by these widely held misconceptions.
ageism
The practice of discriminating against people because they are old; attitudes associated with the practice.
Sexual Orientation
The lesbian folk singer Betsy Rose sings a song about a lesbian telling her mother for the first time that she is a lesbian. In contrast to the shock and consternation that most mothers would express, Betsy Rose’s imaginary mother in the song is delighted and says, “Darlin’, I’m glad you’re gay!” The song is presented humorously, and the audience laughs because it is so contrary to what happens in real life.
Homophobia (the irrational fear and stigmatization of homosexuality) is deeply ingrained in society, and human service workers are not immune to it. It was not until 1973 that the American Psychiatric Association declared that homosexuality was not a mental illness and removed it from its list of psychiatric disorders. Two years later, the American Psychological Association followed suit.
homophobia
An unreasoning fear or loathing of people who have intimate sexual relationships with people of the same sex.
Despite the lack of scientific evidence for regarding homosexuality as an aberrant or degenerative disease, homosexuals have been a stigmatized minority in many societies. They were one of the first groups the Nazis forced into concentration camps in Poland and Germany. They were required to wear a pink triangle as an identifying symbol, in the same way that the Jews had to wear a yellow star. It is important to remember that the mentally ill and retarded were also locked up in the concentration camps, as were Gypsies, Masons, Seventh-Day Adventists, and others whom the Nazis viewed as less than human. When we define anyone as being less human than we are, we have taken a step toward the death camps.
Because they are stigmatized, gays and lesbians often stay in the “closet”—that is, they pretend to be heterosexual. It is often traumatic for them to publicly acknowledge their sexual orientation. It may be especially hard for older people, because the stigma was even more severe in their youth.
As early as 1948, the Kinsey study reported that among men between the ages of 16 and 55, 13 percent were homosexuals for at least three years, 25 percent had more than incidental homosexual experience for at least three years, and 37 percent had at least some overt homosexual experience to the point of orgasm (Kinsey, Pomeroy, & Martin, 1948).
It is a safe bet that, whether you know it or not, you work with, learn with, or are taught by a gay person, whether or not they identify themselves as such. The homeless mother in a battered women’s shelter, the undocumented immigrant from El Salvador in an English as a Second Language program, the man in a nursing home with Alzheimer’s disease, the runaway teenager on the street, your supervisor—any of them could be gay. They are not likely to tell you until they trust you. It is important not to make any a priori assumptions about a person’s sexual orientation. If, for example, you are a hospital social worker and are called to help a man who was brought to the hospital because of a bicycle accident and someone needs to be notified, you might ask him, “Could you tell me the name of someone who is close to you who could come to help you?” rather than asking, “Do you have a wife I should phone?”
As of 2010, same-sex marriage had been legalized in five states—Connecticut, Iowa, Massachusetts, New Hampshire, and Vermont—and Washington, D.C. When even long-term gay couples cannot legally marry, they do not have the same rights as married heterosexuals. Gay companions are not automatically consulted about their mates’ welfare, as are husbands and wives. Occasionally one reads in the newspaper about a gay or lesbian who has had an accident and is seriously disabled. Although the lover has on a day-to-day basis acted as a legal spouse and would logically be the one to care for his or her mate, the parents of the disabled person insist on gaining custody, and the wishes of the accident victim are ignored.
At some point, you might be asked to make a recommendation to a judge in a custody case. As a human service worker, you are more likely to be concerned with the capacity of parents to nurture their child than with that parent’s sexual orientation. Several stereotypes exist about gays and lesbians as parents:
They will sexually abuse children in their care
The children will grow up to be gay
Children will be psychologically harmed by being raised by two parents of the same sex
Children will be harmed by the social stigma
Research has not shown that any of these stereotypes are supported by the facts. Heterosexual men do most sexual abuse of children. Children of gay parents are no more likely to grow up gay than are children of heterosexual parents. (Remember, heterosexual parents raised the vast majority of homosexuals.) Studies that compare children of lesbians and gays with children raised by heterosexuals show that gay men and lesbian parents do not differ in child-rearing practices or lifestyle from other parents. Apparently their children have no more adjustment problems than do other children. “In fact, there is some evidence that children of lesbians have a greater appreciation for diversity of all kinds and value tolerance more highly than others, having seen first-hand the toll that prejudice like homophobia can take” (Appleby & Anastas, 1992, p. 360). For example, the lesbian singers Betsy Rose and Holly Near show appreciation for diversity by signing their concerts for the benefit of deaf people. As for stigma, there is no clinical evidence of stigma or unusual emotional problems in these children (Kirkpatrick & Hitchens, 1985).
New reproductive technologies, especially artificial insemination, have opened up the possibilities for childbearing for younger lesbians. Some gays and lesbians also want to become foster or adoptive parents. “Social workers in medical and child-welfare settings increasingly find themselves dealing with lesbian clients as they give birth, and with gay and lesbian clients seeking adoptive or foster children or who come for help with the vicissitudes of parenting” (Appleby & Anastas, 1992, p. 359).
5.7 Keeping Values Straight in a Time of War
The 9/11 attack on the United States and the subsequent war on Iraq and Afghanistan have created value dilemmas for everyone in the country. Human service workers share in the world’s grief and bewilderment as we try to sort out the issues. How do our core values shape our reactions to this crisis? Does our profession have anything special to offer the world?
Frederic Reamer, a social work professor, looks to the core values of social work as guidance for these times, and his advice is appropriate for all human service workers (Reamer, 2001). One of the core values is respect for the dignity and worth of the person. Social workers (and all other human service workers) have a strong belief in human dignity and worth. But what about our response to the terrorists? Should we also be expected to respect their dignity and worth? “As an analogy, must social workers who help rape victims respect the dignity and worth of rapists? Must social workers who help abused children respect the dignity and worth of the abusers? What, if any, are the limits of social workers’ long-standing commitment to being non-judgmental? In an abstract sense, some social workers argue, practitioners can feel angry toward the rapist or child abuser and still respect that individual’s basic human worth and dignity and right to assistance. It is this respect that gives these social workers the strength, stamina, and fortitude to work with offenders and help them achieve the insights and behavior change that can prevent future misconduct and harm” (p. 23).
Social workers are also called upon to respect individual difference and cultural and ethnic diversity. At the same time, social workers sometimes struggle to distinguish the ethical from the unethical. “At what point does a culturally accepted child rearing practice, such as physical beatings, become an ethically unacceptable form of child abuse? … By extension, at what point does the Taliban government’s treatment of its citizens—especially its women—become ethically intolerable? Cultural relativism and tolerance have their place in social work, but they also have their limits. There is a bottom line in social work ethics. The challenge, of course, is deciding where to draw that bottom line” (p. 23).
In 2003 the state of Massachusetts legalized marriage between two persons of the same gender. In response to this break with tradition, some legislators attempted to amend the U.S. Constitution to make such unions illegal.
Reamer concludes with important advice to all of us: “Social work’s core values can ground us during these frightening times as we seek to regain our balance and equilibrium. If we’re not careful, our understandable outrage, fear, and anguish can lead us to view the enemy as a dehumanized demon that must be annihilated no matter the cost to our own soul. As much as possible, we must resist the temptation to retaliate in a way that compromises our fundamental values and principles” (p. 23).
In addition to examining our individual values, it is important to study the politics of the country’s wars. Spending on war means less money for safety net programs and social services.
5.8 Finding Your Way Through the Maze of Ethical Conflicts
How do we find our way through the thicket of ethical dilemmas and ambiguity? The first thing we need to do is learn to tolerate ambiguity. Rhodes (1989) says that resolving ethical dilemmas is not a hopeless undertaking. First, we need to separate them into those that can be solved and those that demand action but can’t be solved. Human service workers are under pressure to believe that all problems are solvable, yet they are called on to work with problems that nobody has yet been able to solve—poverty, alcoholism, and drug addiction, as well as problems that are an inevitable part of life—old age, disabilities, and death. Rhodes cautions us to “recognize the immensity of the task we are expected to do and the inevitable failures that must result” (1989, p. 9).
Rhodes recommends that we set aside time to focus on the ethical dilemmas we face every day. If we avoid the issues, we will “muddle through,” assuming that we are helping others when we may not be. Agencies could help workers with this by setting aside time for workers to discuss ethical issues. Rhodes says,
Dialogue is central to ethics. Only through sustained and open dialogue can we develop ethical positions.
This assumes that:
We can communicate across different views;
We can be open to each other; and
We need other views in order to fully reexamine our own. (1989, p. 19)
Summary
1. No one is value free. Our values are shaped by many influences: families, friends, school, church, the workplace, and our social class, ethnicity, and gender.
2. The value of self-determination is important in the human service professions.
3. Despite its importance, self-determination is difficult to follow in practice, especially in work with involuntary clients.
4. Decisions about self-determination must weigh the good of the individual against the good of the community.
5. Child-welfare agencies are under fire across the nation. Complaints come from biological parents, foster parents, and advocacy groups.
6. Human service workers disagree about treating clients who are ordered to receive treatment. Some refuse, believing that the client’s right of self-determination is an overriding value. Others believe that they can often overcome resistance and their help will be accepted.
7. Self-determination can be violated by manipulation as well as by overtly coercive methods. Manipulation should be avoided.
8. Some current ethical dilemmas center on the treatment of AIDS patients, the right to die, and reproductive choice.
9. One’s view of human nature shapes the service one gives. Three views of human nature were proposed by Thomas Hobbes, John Locke, and Jean-Jacques Rousseau.
10. Bureaucracies often conflict with meeting the needs of clients and workers.
11. Workers need to take responsibility for their own beliefs and speak out about them.
12. Conflicts about national values affect policy and practice. A mixture of progressive and punitive values shapes welfare policies.
13. Clients are our employers, though they are seldom asked their opinion about our services. Feedback from clients improves practice.
14. Social class and other differences between workers and clients often interfere with giving and taking help.
15. There are misconceptions about the process of aging.
16. Conflicts about sexual orientation affect human service policy and practice.
17. Dialogue is central to dealing with ambiguity. Only through dialogue can we carve out the most ethical positions.
18. It is hard to keep our values clear in a time of war. We offer some guidelines.
Discussion Questions
Although self-determination is an important value in human service work, it is often hard to follow in certain kinds of work. In what ways could self-determination be maximized in the following situations if you were the human service worker?
A parent has been reported as being abusive to a child.
A person who was driving while drunk has been mandated to get treatment.
A delinquent is on probation.
A woman says she would rather die than go through the debilitating processes that are inevitable with her illness. She is fifty years old and has early-onset Alzheimer’s disease. What are your thoughts on this?
You are given the job of leading a discussion between pro-choice and pro-life people. How do you structure this discussion?
In some open adoption arrangements, the biological parent and the adoptive parents continue to have contact with each other after the adoption, and the biological parent is allowed to have frequent contact with the child. What are the possible advantages and disadvantages of this arrangement? Do the same issues that apply to open adoption also apply to artificial insemination, when the child who is born as a result of the insemination is allowed to contact his or her father?
Why do you think that few social agencies have institutionalized a process to get regular feedback from clients?
Web Resources for Further Study
The Hastings Center
www.thehastingscenter.org
The Hastings Center is an independent, nonpartisan, and nonprofit bioethics research institute founded in 1969 to explore fundamental and emerging questions in health care, biotechnology, and the environment.
National Association of Social Workers (NASW)
www.socialworkers.org
The NASW code of ethics is intended to serve as a guide to the everyday professional conduct of social workers.
National Organization for Human Services
www.nationalhumanservices.org
Ethical Standards for Human Service Professionals are on this NOHS web site.
Self-determination theory
Deci, E., & Ryan, R. (2004) Handbook of self-determination research. Rochester, N.Y.,: University of Rochester Press.
