Social Work in the Military:Ethical Dilemmas and Training Implications
Steven H. Tallant, Ph.D., ACSW
University of Wisconsin-Eau Claire
Richard A. Ryberg, Ph.D., LCSW
University of Wisconsin-Eau Claire
Military Social Workers
Most officers and non-commissioned officers throughout the services are unaware of the presence of social workers in their respective branches and the variety of social work services provided by these individuals.Interestingly, social workers have been serving the military since World War I.Harris notes that a Red Cross social worker reported to duty at the U.S. Army General Hospital Number 30 at Plattsburgh, New York, on September 1, 1918. (Harris, 1999).From 1918 until 1945 the U.S. Army relied upon enlisted social workers to provide an array of services.In 1945, commissioned status for social workers was achieved in the United States Army.Since that time there has been a proliferation of both military and civilian social workers.
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.
Ethical Dilemmas in Social Work
Ethical dilemmas are neither new nor unique to military social workers.The issues of ethics and values are well documented in the literature (Reamer, 1995). Historically, social workers in all occupational settings have been faced with daily ethical dilemmas.The earliest known attempts to formulate a way of dealing with ethical dilemmas can be traced back to the 1920s and attributed to Mary Richmond (Pumphrey, 1959). While the nature and complexity of these dilemmas have changed over time, contemporary social workers continue to grapple with difficult ethical dilemmas, as do military social workers.Interestingly, ethical dilemmas are not confined to the practice of social work.
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.
Development and Overview of the NASW Code of Ethics
The National Association of Social Workers (NASW) adopted its first code of ethics in 1960.Since that time there have been two major revisions of the code.The first took place in 1979 and the currentNASW Code of Ethics was approved by the 1996 NASW Delegate Assembly.The NASW Code of Ethics presents the ethical standards (both general principles and specific rules) that professional social workers are expected to follow.
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 professions 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 Codes 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 works 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.
Distinguishing Military Factors Contributing to Ethical Dilemmas
Five factors inherent in military life contribute to the development of ethical dilemmas for military social workers. These factors must be clearly understood to appreciate the complexity and uniqueness of the many ethical dilemmas confronted by military social workers. It should be noted that these issues are not independent of each other. In fact, sometimes the combination or the interaction of these factors increases the possibility of ethical dilemmas occurring. However, for the purposes of this paper, each will be discussed independently. These factors include the dual profession of the military social worker, the multi-purpose role of the social worker as a human service provider, hierarchical structure governed by military law (Uniform Code of Military Justice), dual clients (active-duty and civilians), and geographic and professional isolation. Following a discussion and explanation of each factor, specific examples of ethical dilemmas related to each military factor are presented. In addition, each ethical dilemma is discussed with regards to the ethical standard prescribed by the NASW Code of Ethics.
While is it not the intent of this paper to resolve the identified ethical dilemmas, several of the identified ethical dilemmas are so germane to the every day practice of military social work that they are labeled as core ethical dilemmas. These core ethical dilemmas must be both clearly understood and resolved by all military social workers. If not, these core ethical dilemmas can and often lead to significant stress and eventual burnout for military social workers. The stress and burnout can lead to both an unproductive and unhappy military career. Therefore, these core ethical dilemmas must be identified and resolved prior to or shortly after a social worker enters active-duty. Not every military social worker will be able to resolve these core ethical dilemmas in a personally and professionally satisfactory resolution. This does not imply that the individual is a poor problem-solver, a poor social worker, unethical, or unpatriotic. However, it does imply that they may not be suited for a military career.
The Dual Profession of the Military Social Worker
The military social worker is both a professional social worker and a professional officer.While other social work settings may and often do create role conflict for the social worker, no social work setting is more prone to role conflict than the military setting.
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.
The Multi-Purpose Role of Military Social Work
For the most part, the individual unit where the military social worker provides services can be conceptualized as a human service organization (mental health, family support center, family advocacy, alcohol and drug unit, etc.).One of the hallmarks of the modern society has been the vast proliferation of formal organizations explicitly designed to process and change people.Hasenfeld and English note that human service organizations accomplish their mission by three distinct strategies.First, human service organizations assume the responsibility of socialization by socializing individuals for the roles they will serve society (i.e., basic training, social and recreational centers, etc.)Second, human service organizations assume the responsibility of social control by identifying and removing individuals from their roles in society who fail to conform to role expectations (i.e., law enforcement, legal, medical, social service agencies, etc.).Finally, human service organizations assume the role of social integration by providing the means and resources to help individuals become integrated into the various social units (i.e., counseling, therapy, financial support, family support, etc.) (Hasenfeld & English, 1974).
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.
The Dual Population of Clients Served by Military Social Workers
Another unique factor faced by military social workers is the dual population served.Social workers serve both active-duty and non-active-duty clients.Although most of the population served by military social workers are active-duty service members and their families, social work practice may also include military retirees and their eligible family members as well as certain civilian populations (Garber and McNelis, 1995).
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.
Geographic and Professional Isolation
The last factor is not unique to military social work.However, when combined with the other factors, the result can create an environment conducive for the development of 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.
Discussion of Selected Ethical Dilemmas for Military Social Workers
As previously noted, each of the five factors inherent in military life contributes to the development of ethical dilemmas for military social workers.Most of the ethical dilemmas are due to a combination or interaction of these five military factors.However, for the purposes of this chapter, specific ethical dilemmas are presented according to military factor.It would be impossible to generate a list of all possible ethical dilemmas.Therefore, a few examples are presented to highlight the issues confronted by military social workers. In addition, while the scenarios reflect the authors specific experience with one branch of the military, the dilemmas presented by each scenario can be generalized to all branches of the military.
Scenarios Representing Dual Profession Dilemmas
You are a military social worker assigned to a battlefield unit during Desert Storm.You work in a mental health unit that treats casualties with battlefield stress.Your primary duties include assessment, treatment, and recommendations for disposition of these soldiers.You must make the choice of returning your patients either to their unit or back to the states for further treatment.
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?
You are a social worker working in an outpatient mental health clinic.A young,
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 husbands 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 clients 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?
Scenario Representing Multi-Purpose Role Dilemmas
This scenario deals with ethical issues related to the multiple purposes of social work in the military.It reflects the dilemma of having to choose between the goals of social integration (by providing therapy) and social control (by identifying and removing individuals from their roles in society who fail to conform to role expectations).The same issues of privacy and confidentiality discussed in scenario two apply to this scenario.In addition this scenario involves the ethical issue of self-determination.However, the situation is markedly different than the situation presented in the previous scenario.
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 spouses 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 clients 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 clients 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 clients 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?
Scenario Representing Hierarchical Structure Governed by Military Law
You are a family advocacy officer dealing with issues of family violence. As the base family advocacy officer, you know the wing commander (0-7) very well. In fact, he has written you several key endorsements on your yearly officer performance report. Your are a captain (0-3) up for promotion this year and you believe the general will support you for promotion.
The general calls you at home on a Saturday evening around 11:30 p.m. and tells you that his wife and he just hosted a party for several couples at his home. During the course of the evening, his executive officer (0-6) became drunk and verbally abusive to his own wife. The couple left the commanders house in an argument. An hour later the generals wife telephoned the wife to see if everything had settled down. The executives wife was crying and clearly upset. She reported that her husband had hit her several times and had left the house for the rest of the evening. She did not know where he had gone.
The general orders you to do the following.First, he orders you to go to the home of the executive officer to check on the condition of the wife.Second, he tells you to conduct an assessment on Sunday morning with the executive officer to determine if this is an abusive situation.Third, he tells you to not talk to anybody about the situation.Finally, he tells you to phone him Sunday afternoon with an update on the situation.
As ordered, you go to the executives 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 generals 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 workers 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?
Scenario Representing Dual Population of Clients
You are a social worker working in an outpatient mental health clinic. For the past three months, you have been providing therapy to a 36 year-old spouse of an active-duty
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 husbands 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 clients 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?
Scenario Representing Geographic and Professional Isolation
You are stationed on a small, isolated island in the middle of the Atlantic Ocean.You are the director of an air force family support center.Within your center a total of five individuals deliver a wide range of programs aimed at helping family members cope and adjust to both military life and the overseas environment.Air Force regulations allow personnel in your center to provide counseling services.However, the direct provision of therapy is strictly forbidden by regulation.In fact, headquarters recently relieved the director of a family support center from her duties for providing direct therapy to clients.Interestingly, prior to this assignment you were a clinical social worker providing treatment in an outpatient mental health clinic.Your areas of expertise include both family therapy and crisis intervention.
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 dont 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 wont 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 organizations 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?
Suggested Guidelines for Resolution of Ethical Dilemma
The are many approaches to dealing with the above scenarios.Other axiologists have developed paradigms and models to guide the helping professional in deciding which course of action to take when resolving ethical dilemmas (Levy, 1993, Loewenberg and Dolgoff, 1996, Reamer, 1982).Established practices include using professional codes of ethics, laws, and decision-making models based upon a hierarchical order of values.Each of these is an important tool for the military social worker.
NASW Code of Ethics
The NASW Code of Ethics is the recognized and accepted code of ethics for professional social workers in the United States.All military social workers should be familiar with and use the NASW Code of Ethics as a guideline for resolving ethical issues.First, it is an insightful and invaluable tool.Most of the ethical dilemmas facing military social workers can be resolved by using the NASW Code of Ethics. Second, regardless of membership in NASW, most states use the NASW Code of Ethics in holding social workers accountable for their practice decisions.It is the standard of the social work profession.Even though the Code may on occasion complicate the decision-making process, being a military officer does not absolve one from professional social work obligations.
Social workers must be familiar with local and state laws pertaining to the practice of social work.There are many ways law impacts on social work practice.For instance, laws direct that certain social services be provided for those who need them, they authorize professional social workers to engage in some activities, but prohibit them from others, and they require social workers to report certain information to government agencies (Loewenberg & Dolgoff, 1996).For example, most states require the mandatory reporting of suspected child neglect and abuse.It important to realize a legal act may be unethical and an ethical act may be illegal!Therefore, it is important to know both the law and legal consequences for your chosen ethical decisions.
Familiarization with both the law, including the UCMJ, and NASW Code of Ethics does not guarantee an easy or uncomplicated resolution of an ethical dilemma.Therefore, models have been developed to assist the social worker.The model presented by Loewenberg and Dolgoff has been useful and offers a straight forward mechanism for decision making.
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 Dolgoffs 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 themissionbecausesocial 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.
This paper identified and discussed ethical dilemmas both unique and common to all social work officers.Contributing unique factors related to the military were identified and discussed.Scenarios representing the interaction of these factors were presented.While it is impossible to discuss and resolve all possible ethical dilemmas, a guideline was presented to aid the social work officer when dealing with core and complex dilemmas.This guideline included the use of the NASW Code of Ethics, the understanding of laws, and the application of a decision-making model.Finally, recommendations were made for the inclusion of this topic into appropriate PME channels.
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