Applied Ethics:

1. Applied Ethics: R. Bruce McNellie Ph.D.,LCSW-S,DCSW,LPC-S,LMFT mcnellie@mcnellie.com http://www.mcnellie.com/ethics/ethics.pptx

3. Ethical Issues Reflect Values of the Culture • This is a review of ethical issues and how societal values are reflected in the code of ethics. These impact ethical decisions even when they reflect conscious or unconscious bias. • Schein (1985) suggested three levels.

4. First Level What the culture values: its public works, works of art, museums, hospitals and universities can reveal the value that the culture places on the arts and sciences. The Stonehenge, Roman Coliseum, the Super Bowl, the Election debates, each suggest some purpose related to the prevailing culture of its time.

5. Second Level What is held to be important and what influences behaviors. These are rules or guidelines about daily life, such as the importance of politeness and the elevation of the elderly as decision makers by the Japanese and some other Asian cultures, violations of which bring social sanctions. The importance of reality television, advertising, movies, literature, each play a part in developing what is important.

6. Third Level Values and the assumptions of a culture, such as the world view of our place in it. Are people viewed as inherently good? Does society have an obligation to the less fortunate? Views about taxes and the government, police, military, church, home, parenting, children....

7. Three Cultural Levels These three levels create a platform for a culture’s interactions at all levels (Schein, 1985). • The products unique to a culture: its public works, works of art, museums, hospitals and universities. • What is held to be important and what influences behaviors. • Values and the assumptions of a culture. Schein, Edgar H., Organizational Culture and Leadership (1985). University of Illinois at Urbana-Champaign's Academy for Entrepreneurial Leadership Historical Research Reference in Entrepreneurship. Available at SSRN: http://ssrn.com/abstract=1496184

8. Assessing Cultural Influences (1) What are assumptions about the essential goodness of people? (2) Does the primacy of the individual or the group come first? (3) What value is placed on personal space? (4) What is the relationship between people and their environment? Harmony or domination? (5) How does the society view change? Are progress and changes valued or resisted? (6) What is the importance or value placed on the past, present, and future? Kluckhohn, F. R., & Strodtbeck, F. L. (1961). Variations in value orientations. Evanston, Illinois: Row, Peterson.

9. Conflicts? Wouldn’t it be nice if we had a list of prohibitions and allowed practices for the profession? Part of the reasons we are in ethics training is because this is just not feasible. There are simply too many variables, even if we lived in a monocultural world, and had a set list to follow. It would need to be updated each day.

10. Complications In the real world we find examples that are perplexing: In many cultures the giving of gifts in a professional relationship is not prohibited; however, in some cultures, this may be viewed as a type of bribe. In Japan and China, a small, thoughtful gift represents the presentation of respect and value by the giver and is expected. (Kohls and Buller, 1994).

11. Cultural Relativism The issue of cultural relativism needs to be addressed. Does multicultural competency mean that all cultural values are to be incorporated in ethical decision making?

12. Cultural Foundation of American Ethics For practical purposes we are going to examine what constitutes ethics in in professional life in America? • What issues and behaviors are important? • What constitute the ethical standards of professional conduct? • What do we do when the mores of other cultures interfere with accepted practices?

13. American Ethics In the US, basic ethics reflect Puritan views heavily based on Judeo-Christian and Western laws and principles. The feelings of right and wrong are heavily Bible based, which promote rules and social expectations. Early American influences also include stories that are passed down from generation to generation (think parables) that affect how we should act. Many of these stories drive an ethnocentric view that is a reflection of European Anglo heritage. It is important that this be recognized and how it may bias decision making. US laws and case laws also reflect the views of the philosophers of the Enlightenment.

14. American Ethics These influences permeated the development of laws in America arriving at this value: That natural law affirms inalienable rights that include: (1) life; (2) liberty; and (3) the pursuit of happiness; exercised in an environment in which people are equal under the law.

15. American Ethics In this context, this means that America supports the right to life, liberty and/or ability to dispose of one's personal property in the pursuit of his or her personal life goals and activities.

16. John Calvin Ethics in this fieldis not necessarily a faith based issue, but it reflects much of the teaching of John Calvin, who has been noted as providing the theological underpinnings for at least one of the pressures on the development of the industrial revolution in America. He posed a rather complex view of the concept of predestination. A presumption if one was of God’s elect, one would be successful, thus those who are successful must be of God’s elect, and that wanton consumption was irreverent, thus plowing profits back into business was God’s will. This promoted the amassing of and reinvesting of capital during a time of rapid growth in population and invention. And it influenced a type of moral linkage between business and personal behaviors. http://www.onbeing.org/program/gods-business/feature/ethics-across-cultures/1258

17. Tenets of Mainstream Culture in the US • Right to life, liberty, and the pursuit of happiness exercised in an environment in which people are equal under the law. • For the majority of our society these values are embedded in our life and we do not think much about them. But these beliefs are not necessarily compatible with everyone’s beliefs or ideals.

18. Values in the Code of Ethics Under our code of ethics there are typically six major values that the field supports as the underpinnings of ethical practices: • Autonomy • Nonmaleficence • Beneficence • Justice • Fidelity • Veracity

19. Principal Tenets Likely the most profound or highest value is Autonomy, followed by Justice and Beneficence. This set also supports individual interest over group interest, which can prove complex in application in some settings.

20. Values Inherent in Practice Living in the US and attempting to work within the values of the majority culture, we are presented with a dilemma when faced with cultural issues that might not promote this specific set of values. In some cultures, there are distinct class differences, gender inequities, poor treatment of the rights of children, harsh disciplinary practices, and the placement of the good of the group or family over individual rights, and others. How do we mesh best practice with these differences in a way that honors a multicultural world view and still offers a way to uphold the values of mainstream society?

21. Consider How the Code Reflects Each of These with Respect to the Vignette: • Autonomy • Nonmaleficence • Beneficence • Justice • Fidelity • Veracity

22. Vignettes Also, consider each vignette from the multiple perspectives of: • the client, • a peer, • the therapist, • the supervisor of the employee facing the issue presented.

23. Peer Influence/Consultation, the poor therapist’s best insurance policy. Part of the reason you are here.

24. What is the underlying premise of social work/counseling? What is our role the helping field? Hint: We are not advice givers…

25. How is that working for you….. Dr. Phil McGraw No one ever does anything that does not make sense at the time…

26. Vignettes

27. 10 yr old John’s father is a personal friend. John brought a knife to school and due to the school’s policy, the child is to be sent to an alternative campus for the rest of the year. You are a personal and professional acquaintance of the principal. John’s father has asked you to intervene on his son’s behalf to have the time in alternative school limited or waived.

28. Your child brought a knife to school and due to the school’s policy, the child is to be sent to an alternative campus for the rest of the year. You work closely with several of the school counselors and principals. Call one of them to discuss your son’s situation. Describe this conversation.

29. During an investigation/counseling session involving a couple, one of them confides in you following a session that she/he is having gender issues and wants assistance in this area, but is afraid to share this with her/his spouse.

30. Mary is in the middle of a custody battle. Parents have joint custody. The mother makes regular contact with you and seems reasonable, helpful, caring, and shows tangible interest in the child’s well-being. The father rarely contacts you for any reason. The mother has called to ask if you will testify on her behalf in an attempt to curb visitation with the father and obtain full custody.

31. A parent confides in you that she and her child are HIV positive and asks you not to share this with anyone, especially her husband, to whom she is still married. Both parents are your clients.

32. One of your employees has been in recovery for the past 5 years with three or four relapses, but mostly has been doing pretty well. He is employed and has maintained his job and a home despite the occasional bouts of binging. During your work with him over the past year, a close relationship has developed, and although the relationship has not become intimate or personal, you do care deeply for him and his future. He has applied for a job at a children’s home and for a teaching job at a public school and has asked you for a personal reference. • …. for a professional reference.

33. During a personal meeting with a family in the community you become aware that they have a history of serious mental illness in their family including violent outburst that has put some of the family members in jail from time to time. You later learn that they are the parents of one of your employees or coworkers. Later you become aware of unusual behaviors on the part of the employee.

34. Two of your employees are about equal in ability and skill levels. John is particularly easy to supervise, very compliant, and helpful to you, and you have developed a close friendship outside the office. George is also a good worker, but easily frustrated, especially when presented with criticism. You are friendly with both employees, but the supervision of George seems to take more out of you and leaves you exhausted. Your boss has asked you for an assessment of both for a possible promotion to a new position in a different office.

35. A client is the parent of a 10 yr old child who you are also seeing for counseling. The parent informs you that the child has been recently diagnosed with a terminal illness, but does not wish to tell the child of this condition. The child is wheel chair bound, but is not obviously ill. • Age 5? • Age 15? • Age 17?

36. Your boss shares critical information with you about significant pending job cuts that will affect most of the staff in your office, but asks you to not share this information with anyone else. One of your peers discloses that he/she has been offered a job with another agency and must make a decision by the end of the week. He/she asks for your advice.

37. You suspect an employee is having an affair with a coworker. The employee’s spouse calls you as a friend and asks what you know about it. You would....

38. A trusted, very well-liked secretary has shared confidential information on a child with someone from the community.

39. John, an employee, is in need of an operation that requires a blood transfusion from someone with a rare blood type. His brother, who has been estranged from the family for several years, is a match, confirmed by his past medical history. As John's supervisor, he has asked you to use agency resources in finding his brother and assisting you in contacting him for the purpose of persuading him to offer his blood to save John's life.

40. An employee comes to you complaining that the clothing worn in the office by several other staff is provocative and makes him/her uncomfortable.

41. As a supervisor new to a unit, you believe that the general dress and appearance of employees is less than professional. You should…

42. One employee in your unit has a habit of starting rumors or misstating facts in such a way that causes strife among other staff. You have tried to reassure staff that has complained about her sharing misinformation or spreading gossip, but staff has continued to complain. Before you have a chance to discuss this with the employee, he/she tells you in confidence that she is on medication and suffers from occasional memory lapses exacerbated by stress and is wanting to take a week off to stabilize her medication.

43. Mary is elderly, in fair health, and is living in a home with no electricity and has to carry water to and from a neighbor’s hydrant to flush her toilet and for personal use. She is generally lucid and able to manage self care, but the home is dirty and cluttered. A number of complaints from relatives and neighbors have been made. You have assessed her as competent and safe, though her care is not the best. Someone from the city inspector’s office calls you and offers to drop by to condemn the home if you will take Mary out of the home on an errand. He says he cannot condemn the home as long as someone is actually in it and he can get the landlord to let him in the home.

44. A worker shares with you concern about the quality of life of one of his/her clients. The worker believes that a DNR is needed, but the client is reluctant to accept the idea of advanced directives. The worker is asking for direction in how proactive he/she should be in pushing the client to consider this. The worker expresses strong personal feelings about the importance of everyone doing an advanced directive to avoid prolonged medical treatment when one is terminal.

45. A client repeatedly has attempted suicide and has begged the hospital staff to ‘let him/her go’ the next time.

46. A client with a terminal and painful illness has repeatedly asked you for assistance in committing suicide.

47. A child protective services worker has a biological child who has made friends w/ a foster child at school. The children have repeatedly asked to spend the night with each other. The worker is uncomfortable with this.

48. A 12 year old has been charged with fondling a 9 yr old neighbor. The 12 yr old was placed in foster care when the parents refused to pick him up after he was released from the sheriff’s office. The statement given by the victim describes mutual touching and general exploration without force. The 12 yr old appears immature for his age. He is facing registration as a sex offender if convicted.

49. An employee comes to you complaining that another employee is seeing too much of his/her spouse. The employee expresses anger and asks you to make this stop.

50. Two 14 year old have been charged public indecency. They were caught having oral sex in the mall bathroom. They both entered foster care when the parents refused to pick him up after he was released from the sheriff’s office. They are both facing enrollment as sex offenders if convicted.