Ethical Conflicts in Social Work Practice: Challenges and Opportunities

Most of the moral distress in current literature stems from the health professions research whereas social work scholarship lags behind. This issue seeks to bridge this gap by exploring in a critical way the moral conditions and ethical praxis of social workers in different national, institutional, cultural and political contexts. It also contributes to the general discussion of moral distress by highlighting how moral distress is experienced (if it is experienced) and managed in the context of the profession. This means that the articles here pay special attention to the evolving contexts for social work practice and, in light of the profession's value base and moral commitments, how social workers manage these in the day-to-day arenas of practice (especially Wilson, this issue). In the spirit of Jane Addams (1907), who reminded us from the beginning that ‘the sphere of morals is the sphere of action’ (pp.66), this collection of articles describes the ways in which social work confronts the moral crisis and challenges characteristic of this critical historical stage of the profession.

The articles presented in this issue illustrate how social workers circumnavigate within the troubled waters of the unethical institutional environments of the era in order to preserve their moral integrity. They clarify social workers’ challenges at different levels of practice with individuals, families, community, and policy practice from a variety of national contexts. They convey the conflicts and dilemmas of frontline workers as well as the impact of neo-liberalism and new public management (NPM) practices on how social workers identify, frame and resolve ethical concerns, especially in government and non-profit practice settings in times of austerity and retrenchment. This context focuses on individuals as a source of fault and intervention while obscuring social, systemic factors; rote practices that undermine professional discretion, relationships building, and responding to actual and self-determined goals; and accountability that prioritises quantifiable and market-based markers over real assistance and change.

The issue, comprised of nine articles, addresses the central role of social work education, supervision, and ethics awareness development in preparing future social workers to identify and manage ethical conflicts that arise from a mismatch between social work values and organizational/institutional settings. Together these articles shed light on how social workers address ethical conflicts that arise from tensions between social work values and organisational goals and priorities in different practice settings and workplace environments.

In her study of criminal justice social workers in Scotland, Jane Fenton describes how new contexts for social work education and practice contribute to internalisation of neoliberal norms and values that undermine ethical practice by impeding social workers’ ability to recognise ethical concerns in the first place. Such workplace contexts further hinder ethical practice by making it harder for social workers who do identify such concerns to summon the moral courage to act upon them. Social workers’ increasing atomisation, dwindling access to appropriate social work supervision, and bureaucratic imperatives inhibit reflexive practice and dialogue with peers and clients. The neglect of the moral content of actions, and internalisation of the neoliberal ethos, can lead to adoption of managerial, bureaucratic and technical practice that belies the reality of service users’ lives. The focus on individual responsibility of clients and the accountability of social workers to bureaucratic imperatives hampers critical analysis of structures that might engender radical responses over compliance and collusion.

Afnan Attrash and Roni Strier show how social work moral distress is associated with the privatisation processes in neoliberal transitions. Based on a qualitative study of social workers working in privatised long-term nursing care agencies in Israel, findings revealed multiple expressions of moral distress. Attrash and Strier describe moral distress as emanating from four main sources: illegal actions, violation of caregivers working rights and benefits, clash between professional principles and economic profit considerations, and harm to elderly wellbeing. The study identified three patterns of coping with these forms moral distress: compliance, denial, and resistance. Most participants follow the pattern of compliance and denial and just a minority offers some signs of resistance. Their findings show that even social workers in this long-term nursing context who identify ethical concerns address them – if at all- through covert acts that leave systems unchallenged. Privatisation of the Israeli social services workforce that compromises client well-being also conspires to make it harder for social workers to express their concerns due to their own vulnerabilities. Privatised provision of services with little oversight offers little hope that concerns will be taken seriously, reinforcing social workers’ motivation to overlook such problems or manage them with covert forms of resistance.

Cheryl Hyde's exploratory study shows how the growing employment of contingent workers in a market-driven neoliberal US welfare state can severely compromise practice ethics. Similar to Israeli social workers in a privatised system, this precarious form of labour makes workers more vulnerable in their reliance on employers and less likely to challenge unethical practices or agency policy. It also limits their access to regular supervision, professional peers, and agency support or training. This leaves them unable to consult with others when ethical challenges arise. Hyde's study is novel because it exposes how neoliberalism impedes identification of ethical concerns not only through agency policies ostensibly implemented to influence client behaviours, but also through employment decisions aimed at workers themselves. Neil McMillan, writing about Scottish residential care workers, is also concerned with the impact of neoliberal policies and new managerialism on workers. He theorises that workplaces that prize bureaucratic accountability over love and care will amplify these low-paid and low status workers’ experience of powerlessness and erode their motivation to do the emotionally difficult labour of caring for children in residential placements. Similar to Hyde's contingent workforce, McMillan posits that practices that lead to low social worker morale may prevent them from coming together to help them better understand the social context for the powerlessness that they experience in their own work and in their ability to meet their client needs.

Soile Juujärvi, Elina Kallunki, and Heidi Luostari provide an important counterpoint from Finland in their examination of social workers using Carol Gilligan’s (1982) characterisations of moral reasoning. In contrast with the findings from the US and Scottish context, social counsellors and social workers in Finland identified conflicts and were confident in their ability to successfully advocate for clients. They saw NPM strategies as a means to ensure transparent and equitable access rather than a tool to discipline clients. Masters-level social workers, invoking an ethics of justice, acted in the best interests of clients, primarily by challenging unjust or harmful rules and procedures generated by organisational changes. Bachelors-level social counsellors primarily appealed an ethic of care explicated through maintaining relationships with clients to secure their access to services and considering their particular circumstances when using professional discretion. Juujärvi et al.'s description points to the national context of Finland as more congruent overall with social work values, making rule-based references more likely to reinforce rather than undermine social workers’ identification of and ability to address ethical concerns when they assert moral courage. The social workers in Juujärvi et al. believed that such assertions would be supported through recognition of their professional status and expertise both by themselves (self-confidence) and managers or multi-professional team members. This points to the importance of considering the social-political context in assessing the impact of NPM on neo-liberal inspired policies and programmes. The relatively long tenure of Juujärvi et al.'s study respondents may also help them draw on professional values to use both rules and situational discretion as needed.

Hillary Wilson's practice note (peer-reviewed as an academic paper) shows how the exigencies of managerial health systems that focus primarily on cost to the exclusion of patient well-being expose social workers in health systems to multiple ethical conflicts. Wilson provides a concrete example of the adoption of health assessment tools with older adults as an ethical concern. The study described the use of manualized assessments that rely on decontextualised, singular aspects of a patient's functioning. In contrast, holistic social work assessments probe health concerns as communicated by those experiencing them as well as people's goals and strengths in the context of their families and communities. Social workers are ‘misunderstood or perhaps even seen as disruptive’ by hospital professionals who operate within systems that have developed a range of strategies to speed up the discharge processes. The perception of social workers as disruptive indicates that they challenge the status quo, and begs the question of what makes such moral courage possible for these hospital social workers? Perhaps the existence of, training on, and use of the holistic social work assessment facilitates the identification and articulation of concerns with other hospital protocols. Wilson's practice experience raises additional questions, including whether workplace structures, confidence that their specialised area of geriatric practice, or other factors, may contribute to a more robust social work ethics that facilitates rather than impedes reflexive and critical practice.

Similarly, Theresa Anasti uses Michael Lipsky’s (1980) theory of street-level bureaucracy to show how social workers use professional discretion when working with US-based sex workers. Anasti specifically explores how the emotional and moral discourse surrounding sex work has shaped the response of street-level bureaucrats (SLBs) who work with this population. Frontline service providers negotiate their responsibilities to sex workers amidst conflicting personal ethics and service technologies. Most strikingly, Anasti finds that social workers in her study, when confronted with actual clients or engaged with sex worker activists, utilise their discretion to secure resources for these clients to meet their self-identified needs regardless of the mismatch between agency rhetoric or personal beliefs and client experiences. Social workers in Anasti's study are able to identify and utilise the often conflicting discourses of sex worker agency, abolitionist ideals, and marginalised social status in order to work across professions and agencies to further their own values, provide resources to the clients they serve, and at times educate other professionals in what may be seen as meso-level social change.

Margo Campbell, Anne Dalke, and Barb Toews, in a reflexive article, explore their experiences contending with and managing the many ethical concerns of social work and pedagogical practice within the institutionalised, heavy-handed control of the US prison system. These authors work in the field of restorative justice projects created and led by incarcerated individuals that bring together ‘inside’ and ‘outside’ students and teachers. Campbell et al. show the many ways in which social workers can enact bureaucracy through the performance of expertise, which undermine the self-determination of clients and create further hierarchy within these relationships. Even as they grapple with and are appropriately troubled by their positions of power, they have come to realise the limitations of their knowledge and good intentions through appreciation of what they have learned from their inside partners. These pertain not only to first-person knowledge about being incarcerated, but also about what constitutes meaningful work and how to navigate total institutions that are characterised by unpredictable enactments of control and power with dignity and self-determination. This article provides another clue as to how social workers might better meet the challenges of ethical practice: through working in collaboration with the people and communities with whom we wish to be in solidarity, a model that stresses working with over doing for. Campbell, Dalke, and Toews’ model also helps tie together – without equating – powerlessness, precarity, and being subjected to bureaucratic accountability as a manifestation of dehumanisation and mistrust that social workers and their clients share.

McCarthy, Imboden, Shdaimah, and Forrester suggest that supervision is a critical component of professional socialisation for social workers that helps them develop skills to practice in complex private and public organisations whose values may be at odds with social work ethics. They report findings from a qualitative study exploring the perspectives of social workers from diverse work contexts and experience levels about their experiences managing ethical challenges in practice. McCarthy et al. highlight the importance of quality supervision, early supervisory experiences, components of supervision, interprofessional aspects of supervision, power dynamics, and the function and impact of supervision for the ethical competency of social workers. Supervisors require training that prepares them to help supervisees identify and manage ethical concerns, and practice in interprofessional and dispersed workplaces with limited resources – included limited opportunities for workplace supervision. Similar to the findings of Fenton, Hyde, and McMillan, McCarthy et al. found little discussion of supervision that implicated systemic concerns. This suggests the need for explicit preparation of supervisors to consider the socio, political, and regulatory context as a normalised aspect of supervision.

The articles in this special issue reveal the potential for ethical conflicts and moral distress to create opportunities for shared action aimed at vindicating the ethical mission of the profession in this era of moral fluidity and precariousness. We hope that this invited issue of ESW will contribute to energising the social work academic, educational and practice involvement in the topic. Taken together, the articles point to challenges and opportunities for social workers. Some question whether social workers- especially those whose employment leaves them precarious or vulnerable- are able to recognise situations where their practice options conflict with professional values or obligations (Attrash & Strier; Fenton; Hyde). A hallmark of neo-liberalism is the drawing away of our attention from structures and policies by focusing attention almost exclusively on the individual. We also see that it accomplishes this goal through strategies like NPM, which keep individual clients and social workers so (pre)occupied and isolated as to make it harder for them to detect policies or larger social trends as a cause of their distress (McMillan). Such practices also drive a wedge between social workers and their clients in that imposed calculations of deservingness, supervision, and compliance are prioritised over relationships and social solidarity.

Less frequently, we see some examples where social workers use a form of moral entrepreneurship when they have opportunities for discretion to enact social work values (Hasenfeld 2000; Shdaimah and McGarry 2018). The articles also provide us with clues as to a number of factors that may facilitate recognition of concerns and the moral courage to act upon them (Fenton). These include a larger socio-political context that is congruent with social work values (Juujärvi); a sense of mission and a willingness to work across professions and ideologies to serve their clients (Anasti); models of ethical social work practice (Wilson); and quality supervison (McCarthy, Imboden, Shdaimah, & Forrester). Including communities impacted by the work that we do (Anasti) and allying ourselves with them as equal partners to identify and challenge injustice and harm (Cambell, Dalke, & Toews) are promising strategies to facilitate ethical social work practice: they are also grounded in social work values and obligations. Shared precarity and vulnerability among social workers and clients suggest that these alliances may be welcome and fruitful (Attrash & Strier; Hyde; McMillan).

Social work has always aspired to be a leading light for ethical practice and at various times in our history we have acted as a social conscience to decry unjust and harmful policies and programmes. Even though these radical voices have been on the margins, they were considered exemplary (Specht and Courtney 1994), as evidenced from social work codes of ethics worldwide. Social workers today are confronted with insidious forms of erosion of the social conscience that are harder to identify and challenge. We can view this as a moment of moral distress not only for us as individuals, but for us as a profession. Fenton describes moral distress as an opportunity for learning: a ‘gut check’ for us to slow down and think about the normative implications of our work. For this to be the case, however, we must first recognise that we are facing concerns that have ‘moral meaning’. Social work education and supervision must proactively and explicitly connect social workers to the profession's values and mission or we risk ignoring and reproducing an environment that undermines ethical practice. Social workers must come together to discuss ethical concerns, and dialogue with our affiliated communities. Only then will we have the opportunity, as a profession, to exercise moral courage.