Social
Work in the Military:Ethical Dilemmas
and Training Implications
By
Steven H.
Tallant, Ph.D., ACSW
Associate
Professor
University
of Wisconsin-Eau Claire
&
Richard A.
Ryberg, Ph.D., LCSW
Assistant
Professor
University
of Wisconsin-Eau Claire
While there has been a significant reduction in the number of social workers in the military during the past decade, all military branches continue to use these professionals in a variety of roles.Excluding civilian social workers, the United States Army has 150 commissioned officers serving on active duty (Lockett, 1999).The United States Air Force presently has 225 civilian social workers and 215 commissioned social work officers (Tarpley, 1999).The Unites States Navy employs 400 civilian social workers and 31 commissioned social work officers (Kennedy, 1999).Excluding civilian social workers employed by the U. S. Army this represents over 1,000 social workers. Based on history one can assume that social workers will continue to be an integral part of the United States Armed Forces.
As a profession, social work has a long tradition with the concern of ethical dilemmas. The identification and resolution of ethical dilemmas is a cornerstone of social work education at both the undergraduate and graduate levels. Therefore, an understanding and appreciation for the unique and common ethical dilemmas encountered by military social work is the focus of this paper.
Purpose of Paper
The
purpose of this paper is threefold.First,
to help generate awareness and discussion of these ethical dilemmas and
the unique military factors which help to create these ethical dilemmas
regardless of branch of service or practice setting.Second,
to suggest an outline for the resolution of these ethical dilemmas.Finally,
to discuss the implications of these dilemmas for professional military
education (PME) at all levels.
In
fact, all professionals, regardless of their profession, face ethical dilemmas.
As a result, over time, each profession (i.e. social work, law, medicine,
military, etc.) has developed a method for dealing with ethical dilemmas
unique to their expertise. While there are several methods for dealing
with ethical dilemmas, the most common and accepted method is the development
and implementation of a professional code of ethics.The
development of a code of ethics for the resolution of ethical dilemmas
is instrumental in the development and recognition of a profession by the
larger society.Therefore, one of
the key attributes of any profession is the development and implementation
of a code of ethics.
The
National Association of Social Workers (NASW) developed the NASW Code
of Ethics for the social work profession. However, before we discuss
the development and use of this code of ethics, we need to define the term
ethical dilemma and identify situations that create ethical dilemmas for
social workers.
The
term ethics comes from the Greek root ethos, which means custom, usage,
or habit.But contemporary ethics
goes far beyond mere custom or habit, dealing with professional performance
and sanctions.Professional ethics
are concerned with the correct course of professional actions.Social
work ethics are designed to help social workers decide which of two or
more competing goals is the correct one for the given situational context
(Loewenberg andDolgoff, 1996).
According
to Loewenberg and Dolgoff, a dilemma is a problem situation or predicament,
which seems to defy a satisfactory solution.The
word dilemma comes from two Greek roots: di (double) and lemma (propositions).
Therefore, a dilemma is a predicament in which the decision-maker must
choose between two options of near or equal value. In addition, the dilemmas,
which confront modern professionals, may result from options, which are
not well defined, or from solutions, which create additional possible or
known problems and harm for the problem carrier or for others (1996)
Therefore,
an ethical dilemma can be created because of several different types of
situations.First, an ethical dilemma
is encountered in a situation where the social worker must choose the best
moral course of action in a predicament from which there are two competing
and equal moral choices.However,
these moral choices may be based upon two different moral philosophies
and conflict with one another. Second, an ethical dilemma is encountered
when the decision-maker must choose the best moral course of action without
knowing in advance the outcome of the decision. In the long run, the chosen
course of action may not be beneficial for all parties involved in the
decision or may even harm a party. The final ethical dilemma is encountered
when the best moral choice may not be best for all the individuals involved
in the predicament and, in fact, knowingly cause harm to one of the individuals.Each
of these predicaments can create countless ethical dilemmas for a social
worker. As mentioned previously, the National Association of Social Workers
developed the NASW Code of Ethics to give direction in the resolution
of ethical dilemmas.
In its own words, the NASW Code of Ethics is intended to serve as a guide to the everyday professional conduct of social workers.This Code includes four sections.The first section summarizes the social work profession’s mission and core values.Values include service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. The second section provides an overview of the Code’s main functions and a brief guide for dealing with ethical issues or dilemmas in social work practice.The third section presents broad ethical principles, based on social work’s core values,that informs social work practice.These ethical principles include the following: Social workers’ primary goal is to help people in need and to address social problems; to challenge social injustice; to respect the inherent dignity and worth of the person; to recognize the central importance of human relationships; to behave in a trustworthy manner; to practice within their areas of competence and to develop and enhance their professional expertise (NASW, 1996).
The final section includes specific ethical standards to guide social workers’ conduct and to provide a basis for adjudication (NASW, 1996).These standards concern (1) social workers’ ethical responsibilities to clients, (2) social workers’ ethical responsibilities to colleagues, (3) social workers’ ethical responsibilities in practice settings, (4) social workers’ ethical responsibilities as professionals, (5) social workers’ ethical responsibilities to the social work profession, and (6) social workers’ ethical responsibilities to the broader society.Later in this paper, we will refer to these values, principles, and ethical standards when discussing the unique and common ethical dilemmas encountered by military social workers.
When
discussing the purpose of the NASW Code of Ethics, the Code points
out the complexity of resolving ethical dilemmas.For
example, there is no set of rules that prescribe how a social worker should
act in all situations and the Code does not specify which values,
principles, and standards are most important.In
fact, the Code realizes that reasonable differences of opinion can
and do exist among social workers with respect to the ways in which values,
ethical principles, and ethical standard should be rank ordered when they
conflict. Finally, the Code notes that there are other sources of
information about ethical thinking that may be useful, but notes that social
workers should consider the NASW Code of Ethics as their primary
source.
The
majority of daily ethical dilemmas are no different for military social
workers than civilian social workers.All
social workers, military and civilian alike, need to be familiar with the
NASW Code of Ethics and use it for its intended purposes.In
addition, there are numerous books on the subject to aid the professional
social worker in the resolution of ethical dilemmas (Pumphrey, 1959;Loewenberg
& Dolgoff, 1996; Rhodes, 1986; Reamer, 1982; Suppes, 1991).Another
excellent resource in helping resolve ethical dilemmas is Social Work
Speaks: NASW Policy Statement (NASW, 1994). However, none of these
resources discuss ethical dilemmas unique to military social work.
As
professional social workers, military social workers received the same
education as their civilian counterparts.They
support and believe in the primary mission of the social work profession:
to enhance human well-being and help meet the basic human needs of all
people, with particular attention to the needs and empowerment of people
who are vulnerable, oppressed, and living in poverty (NASW, 1996).Furthermore,
military social workers focus on individual well-being in a social context
and the well-being of society.They
are concerned with and pay attention to the environmental forces that create
and contribute to problems in living.Finally,
military social workers support and use the NASW Code of Ethics
in resolving ethical dilemmas and are held accountable to the social work
profession for their professional actions.However,
they are also held accountable to another profession: the military profession.
Upon
entering the military, military social workers are commissioned as officers.They
are sworn to support the Constitution of the United States, defend the
United States against all enemies foreign and domestic and to follow the
orders of their superiors.
As
with all recognized professions, the military has both a moral base and
an ethical base to the practice of arms (DeGeorge, 1987; Brown & Collins,
1981; Smith, 1988; Watkin, 1979.)In
addition, Huntington had proposed a Code of Military Ethics. His Code of
Military Ethics includes the following:
1.To
prefer peace to war, and realize that the military serves most effectively
when it deters and so prevents war rather than when it engages in war.
2.To
use the utmost restraint in the use of force, using only as much as necessary
to fulfill my mission.
3.To
obey all legitimate orders, but only legitimate orders.
4.To
remember that those beneath me are moral beings worthy of respect and I
shall never command them to do what is immoral.
5.To
be responsible for what I command and for how my orders are carried out.
6.To
never order those under me to do what I would not myself be willing to
do in a like situation (Huntington, 1979).
As
Davenport notes, “the modern officer corps is a professional body and the
modern
military officer a professional man [and woman]. The paramount duty of
the military professional is to promote the safety and welfare of humanity
and this duty, according to military law, takes precedence over duties
to clients, who as his fellow citizens are but a particular portion of
the human race “(Davenport, 1987).
It
is obvious that role conflict will develop for the military social worker.The
military social worker is both a professional social worker and professional
officer. Each profession has its own set of morals, values, and ethics.Each
has it own purpose or mission.This
role conflict will create core ethical dilemmas for the military social
worker. The question is often asked: Can one be both an officer and a social
worker?If so, which takes precedence?Are
there different times or situations when one role takes precedence over
the other?
Interestingly,
this core conflict can be discerned in the article “Military Social Work”
written by David Garber and Peter McNelis and published in the Encyclopedia
of Social Work, (19th ed.).In
the article active-duty social workers are referred to as both military
social workers and social work officers.In
the first description, the proper noun is social workers.In
the second description, the proper noun is officers.
Because
of inherent conflict of interests, most human service organizations are
developed and organized according to only one of the above strategies.Very
seldom in the civilian world does one find a human service organization
where professional social workers engage in socialization, social control
and social integration activities.However,
both social control and social integration activities are inherent in the
role of the military social worker.Regardless
of unit, the military social worker is often faced with providing treatment
for the individual and, at the same time,providing
assessments, recommendations, testimony, etc., for administrative discharge
or other forms of administrative action. A prime example is a social worker
working in the substance abuse field.In
addition, on occasion, military social workers will be called upon to provide
socialization activities such as working with juvenile offenders in coordination
with local law enforcement agencies.These
multi- purposes will create ethical dilemmas for the military social worker.
Hierarchical
Structure Governed by Military Law (Uniform Code of Military Justice)
The
military is organized as a classical bureaucratic organization with a rigid
hierarchical structure. Two of the most distinguishing characteristics
of the military are a clear chain of command and rank.A
chain of command places each organization and leaders of the organization
in hierarchical order.Therefore,
all organizations and leaders of those organizations are clearly subordinate
or superior to other organizations and their leaders.
In
addition to a clear chain of command, all military members have rank.The
rank structure of the military is divided by officers and enlisted members.Each
officer and enlisted individual (non-commissioned officer) are distinguished
by rank.Therefore, every military
individual is either subordinate or superior to all other individuals regardless
of organizational unit.
Military
rules, regulations, and policies are established to insure good order and
discipline within the military.Furthermore,
to insure compliance with these rules, regulations, and policies all military
members are subject to the Uniform Code of Military Justice (UCMJ).The
military justice system is one tool used to correct breaches of discipline;
it protects the rights of both the institution and individual service member.Punishment
may be rendered through nonjudicial punishment (Article 15) or judicial
punishment (court-martial).According
to the UCMJ, military service members do not lie, cheat, steal, or engage
in activities that bring discredit upon the service, nor do they tolerate
those who do.In addition, the UCMJ
specifically states that all officers must become involved when breaches
of discipline occur in their presence and report all such violations to
the proper authorities within their chain of command.
The
chain of command, rank, and the UCMJall
have significant implications for military social workers.While
most civilian social workers are subjected to a chain of command and hierarchical
leadership there are several important and distinguishing differences.
First, military social workers can and often are ordered to perform a task
by either a non-social worker or an individual within their chain of command
who is not their immediate supervisor.Second,
military social workers are heldresponsible
and punished for not following legal orders.Third,
military social workers must work within the boundaries of both civilian
and military law.Finally, military
social workers cannot quit their jobs because they disagree with their
immediate boss or with the chain of command.These
factors, unique to the military context, often lead to ethical dilemmas
for military social workers when working with clients.
Active-duty
members are subject to the Uniform Code of Military Justice (UCMJ).Active-duty
members must follow orders and are held responsible and accountable for
their actions.Civilians do not
have to follow orders and are not held accountable to the UCMJ.However,
family members are part of a family system.From
a systems perspective it is impossible to separate the active-duty family
member from the civilian family member.In
addition, from a systems perspective it is sometimes difficult, if not
impossible, to separate the family from the larger military system from
which it is an integral part. These two realities create ethical dilemmas
for the military social worker.
As
Garber and McNelis note, “at some point in a military career, nearly all
social work officers serve in an isolated or overseas tour of duty” (1995).In
many of these assignments there will be only one social worker working
with a limited number of helping professionals.At
other locations the social worker may be the only provider.In
the United States Air Force these assignments are referred to as “lone
ranger” assignments and are usually staffed by junior officers.In
almost all overseas locations, the military social worker is isolated from
the civilian community and social work colleagues.
In
both isolated and overseas assignments, “the limited availability of resources
in these assignments requires the individual practitioner to develop and
provide a broad range of services” (Garber & McNelis, 1995).While
this allows for professional growth and development it can also create
a host of ethical dilemmas for the military social worker.
One
of your patients is a 24 year old, Sergeant(E-5)
who has been involved in numerous battlefield encounters.He
has received several superficial wounds in the past and has been awarded
several battlefield commendations.In
addition, he has experienced all the horrors of war including the loss
of several close friends.
He
presents with recurring nightmares, intrusive thoughts, sleep disorder,
and survivor guilt.These symptoms
have become progressively worse during the past two weeks.After
two days of rest and relaxed general duties he responds well and many of
his symptoms have diminished.
He
tells you his wife is expecting their second child within a couple of weeks
and she is having complications with her pregnancy.Furthermore,
he tells you that they lost their first child last year to leukemia.His
wife is still dealing with the death of their first child and wants him
home.Because of his battlefield
experience, he believes he has “done his duty.”He
asks you to send him home.
You
receive a call from his commander.His
unit sustained heavy casualties that morning in a firefight.He
needs this NCO returned to the unit as soon as possible.You
must make your decision today.On
one hand, you know he is ready to return to his unit.On
the other hand, as a trained social worker, you want to promote his right
of self-determination.
This
is a core dilemma and is created because of two competing and moral choices
that conflict with one another.This
scenario clearly illustrates the conflict between the competing missions
of the military and social work.The
military social worker must make a decision between mission and client.The
duty of the military professional is to promote the safety and welfare
of humanity through the mission and this takes precedence over the individual
client.Therefore, as an officer,
you need to return him to duty; his unit desperately needs him. However,
as a social worker, you know it is in his best personal interest to go
home and support his wife.
Ethical
standard 1.01 (NASW Code of Ethics) notes that social workers’ primary
responsibility is to promote the well-being of clients.In
general, clients are primary.This
is one of the most important ethical standards in social work practice
today.Social workers are taught
that their primary responsibility is to their client.Social
workers advocate and support what is best for the client.
However,
ethical standard 1.01 (NASW Code of Ethics) also notes that the
social workers’ responsibility to the larger society or specific legal
obligations may on limited occasion supersede the loyalty owed to clients.In
addition, ethical standard 3.09 (a) (NASW Code of Ethics) states
that social workers generally should adhere to commitments made to employers
and employing organizations.As a
military social worker, how will you resolve this core ethical dilemma-
mission or client?
junior
enlisted woman comes to your office stating she is agitated, angry, and
scared.She is the mother of two
small children, ages 3 years and 7 months, and the spouse of a non-active-duty
member.She is a member of a unit
scheduled to deploy on a six-month tour of duty in three weeks.She
holds a high-level security clearance.She
tells you that her husband abandoned her last week and there is nobody
available to watch her children during her six-month absence.Her
Personal Readiness Plan has not been modified to reflect the husband’s
abandonment.
While
in the military for only several years, she has an excellent military record
and plans on making the military a career.She
wants to talk with somebody about the situation and has come to you for
help and guidance.She does not
want to turn to her family for help because they disapprove of her inter-racial
marriage. She is not sure what you can do for her, but feels desperate.She
states that with your help she can resolve the issue herself.She
is looking forward to the upcoming mission and does not want to be left
behind.Finally, she asks you not
to tell her unit, because she is afraid it will hurt her career. She says
her commanding officer is not flexible and will be angry with her.
You
are faced with the dilemma of honoring her request for privacy and confidentiality
or reporting the situation to her unit.Again,
you are faced with conflicting moral choices: mission or client?In
addition, because you have not worked with this unit before, you do not
know how the unit commander will handle the issue.Therefore,
this magnifies your dilemma because you must choose the best moral course
of action without knowing in advance the outcome of the decision for your
client.
The
right to privacy and confidentiality are hallmark social work values.Ethical
standard 1.07 (a) (NASW Code of Ethics) notes that social workers
should respect clients’ right to privacy and ethical standard 1.07 (b)
(NASW Code of Ethics) notes that social workers should protect the
confidentiality of all information obtained in the course of professional
service, except for compelling professional reasons.Ethical
standard 1.07 (c) notes that a social worker may breach confidentiality
when disclosure is necessary to prevent serious, foreseeable, and imminent
harm to a client or other identifiable person or when laws or regulations
require disclosure without a client’s consent.In
all instances the social worker should disclose the least amount of confidential
information that is directly relevant to the purpose for which the disclosure
is made.Finally, ethical standard
1.07 (d) notes that social workers should inform clients, to the extent
possible, about the disclosure of confidential information and the potential
consequences, when feasible before the disclosure is made.
The
NASW Code of Ethics gives good direction for this scenario. First,
a military social worker should always address the limitations surrounding
the issue of privacy and confidentiality before meeting with an active-duty
member. However, does the social worker in this scenario have compelling
professional reasons to breach privacy and confidentiality? If so, what
are those compelling reasons?Is
there a regulation requiring disclosure of this information? Is there serious,
foreseeable, or imminent harm? Is it because of themission?
Is it because of the children?Is
it because of her security clearance?Does
age, gender, or rank make a difference upon the decision?If
confidentiality is broken, how much information does the commander need
to know to make a decision regarding the individual?
You
are a social worker in an inpatient treatment center for alcoholism.In
addition to providing therapy for the inpatients, you are responsible for
conducting weekly drug and alcohol assessments.
For
the sake of discussion, the same individual in scenario two is a patient
in your treatment center.The situation
for the client is the same as in scenario two except for three factors.First,
she is not scheduled for deployment. Second, she does not hold a security
clearance.Finally, following her
spouse’s abandonment, she received a D.U.I. (BAT .195) and was diagnosed
as an alcoholic.She was referred
to your center for treatment.
She
has responded remarkably well to treatment.Self-disclosure,
participation, honesty, and openness to treatment characterize her progress.She
has become actively involved in Alcoholics Anonymous (AA).Her
prognosis is excellent.She is looking
forward to returning to her family and job.
During
treatment, she denied the use ofillegal
drugs.However, during her last
week of treatment she tells members of AA that she used multiple drugs
prior totreatment.In
fact, she reported using marijuana regularly and abusing prescribed medication.She
tells the AA members she is confident that she will remain clean when she
returns to her unit.
One
of the AA members is a recovering alcoholic and a member of your staff.She
tells you about the client’s self-disclosure.You
ask the client about her remarks and she confirms her previous drug history.She
said she lied about her previous drug history because she feared she would
lose her career.As with the AA members,
she tells you she wants to be clean and believes she is well on her way
to recovery.You believe her.
Current
regulations prohibit marijuana users from remaining on active-duty.If
you report this to her commander she will be administratively discharged.
Again,
this time you must choose between two competing and equally moral choices:
social integration and social control.To
complicate the decision, selection of the correct moral choice may cause
harm to one of the individuals involved.For
example, if she is discharged from the military what will she do and what
effect will this have upon her children?Do
you follow the regulations and report her past drug usage or do you honor
privacy, confidentiality, and self-determination?
The
same issues of privacy and confidentiality discussed in the second scenario
must be applied to this scenario.In
addition, the issue of self-determination must be confronted.
As
with privacy and confidentiality, social work has long valued the concept
of self-determination.As ethical
standard 1.02 (NASW Code of Ethics) notes, social workers respect
and promote the right of clients to self-determination and assist clients
in their efforts to identify and clarify their goals. Clients must have
the freedom and power to change their lives as they see fit.However,
ethical standard 1.02 (NASW Code of Ethics) does note that social
workers may limit client’s right to self-determination when, in the social
workers’ professional judgment, clients’ actions or potential actions pose
a serious, foreseeable, and imminent risk to themselves or others.
How
does the social worker resolve this dilemma?Since
treatment appears to be effective, is there a need to discharge this individual?In
other words, is social control needed after social integration appears
effective?Who should make that decision,
the commander or the social worker?More
importantly, does the social worker have merit to limit the client’s right
to self-determination?Are there
enough data to suggest serious, foreseeable, and imminent risk to her or
others?If so, what are that data?Do
you believe she will relapse and harm herself, her children, or the mission?
Does the client have the right to prove herself? Should her commander be
involved in this decision?
If
you choose to inform her commander, what and when will you tell the client?
What and how much will you disclose to her commander?If
you choose self-determination, and keep this information to yourself, how
will the military be able to monitor her aftercare?
As
ordered, you go to the executive’s house.The
wife has been hit several times in the face, but refuses to go to the hospital.
She reports that the abuse has gone on for years and she wants her husband
to get help.She asks for your help.
The
next morning you meet with the executive officer and he admits he hit his
wife, but denies he “has a problem” with abusive behavior.He
blames the incident on having too much to drink.He
refuses treatment and says “Captain, I am a Colonel--get out of my life!”
After
conducting your assessment, you come to the conclusion that this couple
needs immediate help.You believe
the incident should be opened as an active family advocacy case.You
report this to the wing commander.He
orders you to keep this case “off the record” and not to discuss the situation
with anyone. The general says he will take care of the situation.He
assures you that he will get this couple some help.In
fact, he tells you that he will “order” his executive officer to get help.What
will you do?How will you handle
this situation?
While
this scenario deals with the nature of the dual profession, it highlights
the issue of power as it relates to chain of command, rank, and military
justice.Some individuals may use
their position within the chain of command and their rank to try and influence
you in your decisions as a professional social worker.Will
you be an officer and follow orders or will you be a social worker and
report the incident so you can get help for this couple?
Regardless
of the legality of the order, the dilemma occurs because the chosen course
of action may, in the long run, not be beneficial for all parties involved
in the decision or may even harm a party.If
you ignore the situation, there may be additional harm to the wife-she
may be killed or seriously harmed in the future!If
you report the incident, there may be harm to your career-you may be passed
over for promotion.
With
regard to social work there is good support for reporting the incident.
As mentioned previously, ethical standard 1.01 (NASW Code of Ethics)
says your primary responsibility is to promote the well-being of clients.Reporting
the incident is best for your client (the wife).Furthermore,
as a professional social worker you have an ethical responsibility to the
social work profession.Ethical standard
4.04 (NASW Code of Ethics) says social workers should not participate
in, condone, or be associated with dishonesty, fraud, or deception.One
could easily argue that by following the general’s orders you would be
participating, at minimum, in deception.Finally,
ethical standard 3.09 (c) (NASW Code of Ethics) notes that social
workers should take reasonable steps to ensure that employers are aware
of social worker’s ethical obligations as set forth in the NASW Code
of Ethics and of the implications of those obligations for social work
practice. You could inform the general of your dilemma and tell him why
you must report the incident.
However,
officers are sworn to follow the legal orders of their commanders.Orders
can be legal, but unethical. This may well be one of those cases.How
will you handle the dilemma?Would
your decision be different if you were not up for promotion?Would
your decision be different if a squadron commander with the rank of major
(0-4) gave the same order?
E-7.She
initially presented with complaints of anxiety and insomnia.Over
the past several months you have gained her trust and confidence.
During
your last visit with the client she reported the following facts to you.
Her husband works in the intelligence field and has a high-level security
clearance. She said that her husband is a “heavy drinker ” drinking alcohol
3-4 times per week and consuming approximately 15-18 beers per occasion.He
has maintained this drinking pattern for “years” and she says he is “just
one of the guys”.She does not believe
he is an alcoholic.
However,
she is concerned because, recently, he has begun discussing classified
material when he drinks.Lately,
the amount of disclosure has increased. She is not sure, but believes he
has disclosed classified material on occasion to his friends while they
were at the NCO Club.She is more
concerned about the disclosure of classified material than his drinking.She
is concerned about his career and how these disclosures could affect “their
retirement”.She confronted her husband
regarding his disclosures.He reports
blackouts and does not remember discussing any classified material.He
says he will cut back on his drinking.She
believes him. She wants to know how she can help him cut back on his drinking.She
wants to know about blackouts.What
causes them?Is there any way to
prevent them?
Your
client has not requested help for her husband.When
you share your concerns regarding her husband she points out that she is
the client and he does not need professional help.All
she wanted was information and advice.She
believed she could trust you with this information.He
can retire in one year and she does not want to get him in trouble. You
tell her you need to inform her commander about her husband’s behavior.
She becomes extremely upset, anxious and pleads with you not report the
situation.
This
scenario is indicative of problems often encountered when working with
both civilian and active-duty populations.The
problem arises when a civilian spouse discloses information regarding the
active-duty member. The social worker must decide what to do with the information.The
dilemma arises because the chosen best moral choice for the social worker
may not be best for all individuals involved in the predicament, and, in
fact, may knowingly cause harm to one or all of the individuals.
On
one hand, according to the NASW Code of Ethics the social worker
should respect the privacy, confidentiality, and self-determination requested
by the client.The arguments for
respecting these issues were presented in scenarios two and three.On
the other hand, the husband has engaged in serious misconduct.Disclosure
of classified information could cause direct harm to the military mission
and is in violation of military law.As
noted previously, as an officer, the UCMJ specifically states that you
must become involved when breaches of discipline occur in your presence
and report all such violations to the proper authorities within your chain
of command. Does second hand information learned in therapy constitute
“in your presence”? If so, does this information take priority over the
issues of privacy, confidentiality, and self-determination? Finally, ethical
standard 1.07 (c) notes that a social worker may breach confidentiality
when disclosure is necessary to prevent serious, foreseeable, and imminent
harm to a client or other identifiable person or when laws or regulations
require disclosure without a client’s consent.
What
would you do in this situation?Would
your decision be different if disclosure of classified material were not
the case, but the client told you her husband was having a sexual affair,
which is also punishable under the UCMJ?What
if the husband were not taking official leave for days he did not work?Does
severity of crime make a difference? If so, how does one measure severity
of crime and who has the authority to determine the severity of the crime?
The
installation hospital is located next door to the family support center.Another
Air Force social worker, a close personal friend and colleague, is serving
in a lone ranger billet as chief of the mental health clinic. There is
no other mental health provider in the hospital.In
fact, the only two social workers on the entire island are you and your
colleague.By regulation, the mental
health clinic is mandated to provide therapy to both active-duty members
and their families.
Due
to organizational mission and geographical isolation, family members experience
a high level of stress at this installation.As
a result, family dysfunction, separation, and divorce run high. Families
are begging for help.Your colleague
at the mental health clinic works 12-hour days to meet the overflowing
demand for family therapy.He provides
an excellent service, but just cannot provide service to all the families
requesting help.Because active-duty
members have priority in the mental health clinic, there is a one-month
waiting list for couples.
It
is a very small installation.There
are only ninety-seven commissioned officers.As
a result, you personally know every officer on the island.In
addition, you personally know about one-quarter of the enlisted personnel.
Everybody lives, works, and recreates together.
It
is a Friday morning. You receive two phone calls within 45-minutes of each
other.The first call is from the
squadron commander (0-4) of the transportation squadron.One
of her key non-commissioned officers got into an argument with her husband
the previous night.The husband is
threatening to return to the states with their two children. He is not
active-duty and cannot be forced to stay on the island.In
addition, the military cannot prohibit him from taking his children.After
meeting with the squadron commander and the first sergeant, the husband
agrees to stay, if, and only if, they can receive marital therapy.He
wants therapy to start immediately.They
cannot get into the mental health clinic for one month. The squadron commander
asks you to see the couple. She says that everybody on the island knows
the regulation, could care less about it, and nobody will ever report this
to headquarters.She is doing her
very best to take care of her troops.
What
will you do?Will you provide therapy
regardless of the regulation?
The
next call comes from the first sergeant of the supply squadron.One
of his troops is also having marital problems.He
is a young, recently married airman.The
husband is 20 and the wife is 19 years old. They have no children and she
wants children now.She has been
on the island only four months.The
first sergeant found out that the couple is having acute, sexual problems.They
have requested sexual therapy to enrich their marriage and, hopefully,
have children.Nobody on the island
provides this service and you are neither qualified nor licensed to provide
sexual therapy.However, you are
well read on the subject matter and your last supervisor was a licensed
sexual therapist.The first sergeant
asks you to work with this couple.You
inform him you are not licensed to provide sexual therapy.He
becomes upset with you.He says,
“If you don’t provide this service than nobody will.”He
questions your commitment to people and the mission.He
asks you why you chose social work as a profession, “but won’t help people
when they ask for your help.”The
first sergeant ends by saying, “You can help this couple!”
What
will you do?Will you provide sexual
therapy regardless of licensure and professional competency?
Both
scenarios are indicative of the remote assignment. Tremendous pressure
is often placed on social workers to provide services they are prohibited
from delivering.The dilemma arises
because the social worker must make a choice between two moral choices
that conflict with each other. The choice is to obey the law or regulation
or provide much needed services. In addition, choosing to obey the regulation/law
may cause harm to the clients, because their needs will go unmet.However,
while these two scenarios are similar they are also quite different in
nature.The first scenario deals
with ethical issues related to commitments to employers.The
second scenario deals with ethical issues related to competency.
The
first scenario asks the social worker to perform a duty that he/she is
quite capable of performing.In
fact, the social worker in the scenario has training and experience in
providing marital therapy.It is
a question of disobeying a regulation.The
ethical standards conflict with each other on this issue.Ethical
standard 3.09 (a) (NASW Code of Ethics) states that the social worker
should generally adhere to commitments made to employers and employing
organizations.You have made a commitment
not to provide therapy and, therefore, should adhere to your commitment.However,
ethical standard 3.09 (d) states that social workers should not allow an
employing organization’s policies, procedures, regulations, or administrative
orders to interfere with their ethical practice of social work.One
could argue that under the circumstances, this regulation is unethical
because it prohibits the social worker from his/her primary responsibility
and commitment to clients.However,
should an officer ever willingly violate a regulation?
The
second scenario asks the social worker to perform a duty that he/she is
not trained to perform.The NASW
Code of Ethics is much clearer on this issue. Ethical standard 1.04
(a) states that social workers should provide services and represent themselves
as competent only within the boundaries of their education, training, license,
certification, consultation received, supervised experience or other relevant
professional experience.However,
because of the unique conditions creating this dilemma, could a social
worker justify providing this service?
Their
Ethical Principles Screen consists of seven ethical principles rank ordered
from most to least important value. The reader is referred to Chapter Three
in Loewenberg and Dolgoff’s Ethical Decisions for Social Work Practice
for an in-depth discussion regarding each ethical principle. The principles
are as follows:
Ethical
Principle 1Principle of the protection
of life
Ethical
Principle 2Principle of equality and
inequality
Ethical
Principle 4Principle of least harm
Ethical
Principle 5Principle of quality of
life
Ethical
Principle 6Principle of privacy and
confidentiality
Ethical
Principle 7Principle of truthfulness
and full disclosure (1996)
If
a dilemma arises during an intervention, the social worker identifies the
ethical principles defining the dilemma.The
social worker must compare the ethical principles and decide which principle
is of higher value according to the Ethical Principles Screen.The
social worker selects the highest valued principle in resolving the ethical
dilemma.
As
discussed previously, the military is unique in that everyone working for
the military is working towards the mission. Mission comes first.Military
social workers must always support the mission. It is your sworn duty as
an officer and your commitment to the armed forces in general and your
military organization in specific.Furthermore,
the NASW Code of Ethics supports commitment to the mission becausesocial
work officers have responsibilities to both the organization (ethical standard
3.09) and the broader society (ethical standards 1.01 and 6).
Therefore,
a modification to the Ethical Principles Screen is needed for military
social workers in the resolution of core dilemmas.Since
military social workers are sworn to support the mission, and the mission
is the primary means of protection of life for humanity (Davenport, 1987),
Ethical Principle 1, principle of the protection of life, must incorporate
the military mission.Our model is
modified to reflect mission:
Ethical
Principle 1Principle of the protection
of life/military mission
Ethical
Principle 2Principle of equality and
inequality
Ethical
Principle 4Principle of least harm
Ethical
Principle 5Principle of quality of
life
Ethical
Principle 6Principle of privacy and
confidentiality
Ethical
Principle 7Principle of truthfulness
and full disclosure
Application
of the modified-model can be applied to each of the scenarios in this chapter.For
example, scenario one, the battlefield stress scenario highlights the ethical
dilemma of choosing between military mission and autonomy and freedom of
the individual.Based upon our modified-model
the social worker would return the soldier back to his unit.The
same is true for scenario five.Self-disclosure
of classified material threatens the accomplishment of the military mission.Since
the principle of the protection of life/military mission is paramount to
the principle of privacy and confidentiality, the social worker would take
appropriate action to inform the proper authorities of the alleged security
violation. The two scenarios
just presented have clear implications for the success of the mission.
However,
it should be noted that not every ethical dilemma has the same impact upon
the mission.Therefore, the social
worker must assess the degree to which the mission is impacted.Scenario
three is an example where one could argue that the mission will not be
jeopardized if the individual is returned to active duty.In
addition, one could argue that it is in the best interest of the mission
to keep this individual on active duty.
While
the Ethical Principles Screen will help in the resolution of many ethical
dilemmas, it will not resolve all dilemmas.The
social work officer works in an environment conducive to many complex and
conflicting situations.It is characteristic
of social work in the military and the successful social work officer will
become proficient, if not completely satisfied, in resolving these ethical
dilemma.
Professional
Military Education (PME)
Social
workers, both military and civilian, need formal education and training
regarding the successful resolution of ethical dilemmas encountered in
the military setting.Social work
officers need to receive this education and training within a formal educational
setting as soon as they enter the military.Civilian
social workers need to be made aware of these issues prior to employment
and should receive in-service training as soon as possible.This
training will enhance their effectiveness as social workers and reduce
stress and burnout.
Commanders
and non-commissioned officers need to be aware of the ethical dilemmas
encountered by military social workers.This
training should be incorporated into the appropriate PME activities. This
awareness will enhance collaboration among military social workers, commanders,
and supervisors; resulting in better utilization of human resources as
it directly relates to the successful completion of the military mission.
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