Social Work Ethics: Confidentiality, Boundaries, and Technology

Introduction

Social workers, like many other professions, are faced with a number of ethical concerns at work. It is important to examine the social work values concerning confidentiality on a macro systems level.

Ethical Foundations and Confidentiality

Various professional codes address confidential information. As one source notes, "there is no doubt that confidentiality is a professional obligation. It is a central ethical concept in the professional-client relationship along with veracity, integrity, fidelity, charity, and compassion" (Pinch, 2000).

While confidentiality is often associated with terms such as trust and privacy, these concepts are actually distinct. "Private or privacy more specifically relates to keeping to oneself, a legal right to be free from invasion, a condition of limited access, as well as social separation, and psychological escape. Private is a more global term that suggests inaccessibility in at least three forms: physical, dispositional, and informational, with only the informational form (verbal or written) relating to confidentiality" (Pinch, 2000). In the workplace, confidentiality is addressed as a moral and professional issue.

The client-professional relationship represents a major confidentiality venue. Health professions such as social work "codify their obligations related to client privacy" (Pinch, 2000). Some situations have resulted in the enactment of laws and legislation to protect specific information, such as the "U.S. Federal Privacy Act of 1974, which included reference to some medical information and records" (Pinch, 2000).

Professional Boundaries and Values

There are boundaries which social workers must observe. "Boundary crossing can often be extremely helpful, whereas boundary violations are usually harmful. Many social workers and therapists confuse the two" (Lazarus, 2003). Social workers tend to function defensively due to fear of reprimand from professional organizations. It is important for the social worker to "appreciate the significance of confidentiality, integrity, respect and informed consent" (Lazarus, 2003).

The ethical decisions social workers must make "are shaped by the decision maker and the process used to resolve ethical dilemmas" (Mattison, 2000). Social workers have systematic guidelines which provide a sound method to make decisions and assist them in resolving ethical dilemmas. However, "it is inevitable that discretionary judgments will condition the ultimate choice of action" (Mattison, 2000).

Ethical Decision-Making in Practice

A number of variables influence social workers, which include "professional roles, practice experiences, individualized perspectives, personal preferences, motivations, and attitudes" (Mattison, 2000). Social workers can use reflective self-awareness to note value preferences and ways the values unintentionally affect resolution of ethical dilemmas. Social workers can gain insight into value patterning with an awareness of how they prioritize values and ethical principles.

Social workers all agree that "the principles of confidentiality and a respect for a client's right to self-determination are core values to uphold" (Mattison, 2000). A social worker may feel compelled to recognize the client's right to self-determination and therefore would not consider superseding the client's right to confidentiality. If the social worker "accepts that the obligations to maintain and protect client confidence and to foster self-determination are central, it would be inherently wrong to violate these under any circumstances. The fact that the client is 14, or any other age, does not change the imperative to uphold the rules, even if doing so results in harm to the client or client system" (Mattison, 2000).

The social worker must explore all aspects of a case and collect any information available in order to understand the current situation of the client. An example of this would be a case where an underage girl was pregnant, in which the social worker would explore if "the limits of confidentiality were explicitly reviewed, and ethical components such as the extent client self-determination should be actualized in practice" (Mattison, 2000). The social worker needs to identify the value tensions in cases such as underage pregnancies, which may include "the social worker's duty to maintain client confidence versus serving the perceived best interests of the family system; the adolescent's right of self-determination versus the parents' right to know that their daughter is pregnant; the adolescent's right to autonomy versus the health and safety needs of the unborn child; and the legal obligations regarding the protection or disclosure of the confidential information versus the moral obligation to serve the best interests of the adolescent" (Mattison, 2000). The social worker must examine the Code of Ethics to determine his or her specific obligations, explore potential consequences of actions taken, and consider how failing to abide by legal obligations could impact the social worker's interests.

Professionals periodically face new challenges in retaining confidential information. One of the most current challenges concerns "the computer storage of information and worldwide communication via various networks that can increase access to even the most sensitive information" (Pinch, 2000).

The National Association of Social Workers (NASW) Code of Ethics states "that social workers should critically examine and keep current with emerging knowledge relevant to social work" (Finn, 2002).

Technology Challenges in Social Work

One of the latest trends in social work is e-therapy websites which are "run by a variety of professionals, including social workers, and offer a wide range of services for a number of issues" (Finn, 2002). E-therapy involves the "exchange of one or more asynchronous email messages between a practitioner and a client. Some online practitioners offer 'chat,' in which messages are exchanged in real-time, or two-way video conferencing, in which video images are available to the same time email messages are exchanged" (Finn, 2002). These recent trends threaten to compromise the confidential exchanges between a client and social worker.

The NASW Code of Ethics specifies that "social workers must take precautions to ensure the confidentiality of client records that are transmitted through electronic communications" (Finn, 2002). The NASW has implemented a policy concerning this issue which states "it is important that the use of technology in social work be directed by the social work values and ethics that are the essential principles of the profession" (Finn, 2002).

The Joint Working Group on Telemedicine (JWGT) reported to the U.S. Congress that "Given telemedicine's rapid technological changes, most technical standards, and educational and clinical practice guidelines for telemedicine are either in the early developmental stages or non-existent. A few areas of ethical concern, however, have been consistently identified in the professional literature: security and confidentiality, licensure, and liability" (Panos, 2002).

Videoconferencing and Electronic Confidentiality

Privacy advocates for the U.S. Department of Health and Human Services (HHS) state "security refers to the safeguards used to protect confidential information, which in turn is defined as sensitive information requiring protection and limited access. They point out that security and confidentiality are the most commonly cited ethical concerns of telemedicine" (Panos, 2002). Telemedical technology allows information to be shared among professionals quickly and with ease, raising concerns about who will view the information and when it will be shared. The effortlessness "with which information can be shared using this technology significantly reduces the client's ability to determine who will have access to their personal medical and mental health information, and under what circumstances" (Panos, 2002).

Social workers who use their own personal computers or those in a small office do not receive the same benefits as professionals working for government agencies or institutions, such as "negotiated bilateral governmental agreements or carefully formulated institutional procedures. In this area where there are no clearly defined ethical guidelines, agencies are forced to follow their own professional judgment in determining appropriate protocols and standards" (Panos, 2002).

The Association of Social Work Boards (ASWB) instituted the Model Social Work Practice Act in 1997 to address the issue of telecommunication across state lines and confidentiality. It states "while federal legislation or the judiciary may have the final word on regulating professions across state line, this section is designed to specifically address the issue of where practice take place. ASWB believes social work practice takes place where the client or patient is located when receiving service. Because the Board's central mission is to protect the public in its state, it must make every effort to regulate the practice of social work being received in that state, regardless of the location of the social worker providing the services" (Panos, 2002). The ASWB supports the opinion that electronic practices need to be regulated to safeguard the client's interests.

Since confidentiality and security are the major concerns regarding videoconferencing technology, professionals are "ethically bound to assess the adequacy of measures used to ensure security and confidentiality" (Panos, 2002). The monitor used during sessions must be located where it cannot be viewed by others, and the social worker should also ensure auditory privacy of the session, as these are significant and realistic issues. If privacy cannot be maintained, the social worker should either move the session to another venue or reschedule the session completely.

Confidentiality should be maintained by implementing protocols such as "using initials or codes rather than identifying information to describe clients during sessions. The manner in which videoconferencing is compacted and transmitted should make it unlikely for a hacker to access information. The social work profession needs to monitor international, federal, and state laws that would enable dangerously open or less stringent privacy protections for the client" (Panos, 2002).