Consulting
by Allan Barsky, JD, MSW, Ph.D.
Students do it. New social workers do it. Even experienced practitioners do it.[1] Social workers of all ranks and levels of practical experience can benefit from ethics consultation. The purpose of this article is to offer guidance on how to make the most of ethics consultation.
What is Ethics Consultation?
Ethics consultation refers to a process of facilitating critical thinking and empowering social workers (or others) to make effective decisions regarding ethical dilemmas, violations, questions, and processes for dealing with them. Consultants provide support for decision making; however, consultants do not provide legal or ethical advice.
Although the role of an ethics consultant shares some similarities with the role of a supervisor, there are significant differences. Within an organizational context, supervisors are specifically mandated to oversee the performance of frontline social workers; in contrast, social workers may seek help from consultants, but consultants are not responsible for overseeing their job performance. Both supervisors and consultants may facilitate critical thinking; however, supervisors may also provide social workers with specific guidance and direction. Supervisors may impose rewards or sanctions on workers, depending on whether the worker follows the supervisor’s guidance and advice. Consultants do not have the authority to impose rewards, sanctions, or other consequences.
Ethics consultation and supervision are not mutually exclusive processes. Supervisors may suggest consultation to assist the supervisor and worker with decision making. Conversely, ethics consultants may invite workers to consider whether they should seek the advice of supervisors. Supervisors have administrative responsibility and accountability within the agency. Although some consultants work within the organization (e.g., for an ethics committee), others work outside the organization.
Why Consult?
The primary reason for seeking ethics consultation is to make better decisions regarding how to manage challenging ethical issues. Social workers can benefit from the expertise and experience of consultants, as well as their ability to help workers reflect on ethical issues from various perspectives. Because consultants are not directly involved in the situation giving rise to the ethical issues, they may offer emotional distance and objectivity. They may also help workers attend more effectively to the emotional and relational experiences of clients, family members, or others affected by issues.
Ethicist Stanley Brodsky suggests that when we are faced with ethical dilemmas, we should feel anguish. He further suggests that we should not anguish alone. Seeking the help of a consultant helps us deal with the anguish.
In terms of risk management, seeking consultation reduces the risk of malpractice. When faced by challenging ethical issues, it is prudent practice for workers to seek consultation. Consultation may ensure more thorough deliberation and critical thinking than working through the issues without help.
When Should Social Workers Consult?
Ideally, social workers seek consultation as a preventive measure, before problems arise. Thus, when setting up a private practice or developing policies for a social agency, social workers may request consultation for how to manage ethical concerns such as informed consent, confidentiality, documentation, clients with homicidal ideation, or potential conflicts of interest. Workers may also seek consultation to assist with ongoing professional development.
Consider, for instance, a social worker who is unsure how to respond to subpoenas. Rather than waiting to receive a subpoena, the worker seeks consultation as part of an ongoing professional development plan. Alternatively, social workers may seek consultation when dealing with a specific ethical dilemma, for instance, how to respond to a values conflict between the worker and client. In some instances, workers seek consultation after a problem has arisen - for instance, someone has gained unauthorized access to client records and the worker needs assistance on how to respond to the breach of confidentiality. Timely consultation can help workers manage breaches by helping them identify appropriate corrective actions.
With Whom Should Social Workers Consult?
Although some ethics consultants have formal ethics consultation training, many do not. Determining whom to consult depends on the nature of the issues and type of consultation that is needed. In many cases, it is useful to have a consultant with intimate familiarity with the organization’s policies, practices, procedures, and client populations. Consulting someone within the organization means that the consultant may be familiar with various factors affecting the decisions to be made. Another advantage of consulting within the organization is confidentiality: workers often inform clients that they may share information within the organization in order to provide the best service possible. When seeking outside consultation, workers should consider whether to request client consent. Although workers may be able to seek outside consultation without sharing identifying client information, client consent may be necessary when the worker needs to share identifying information with the outside consultant.
When choosing consultants, consider whether you need someone with specific expertise with a particular client population, familiarity with social work ethics, or knowledge of interprofessional ethics. When working with clients from another culture, for instance, it may be helpful to seek consultation from someone belonging to that cultural group. Although social workers often seek ethics consultation from other social workers, they may consider consultations from attorneys, psychologists, physicians, or other professions, particularly when the issues involve practitioners from different professions.
The National Association of Social Workers (NASW) offers ethics consultation to its members. Its consultants are particularly valuable in helping members consider relevant sections of the NASW Code of Ethics. When the issues are related to licensure, malpractice, or interprofessional practice, they may suggest seeking help from the state licensing board, an attorney, or consultants who are familiar with the other relevant codes of ethics.
One of the most important attributes of a good consultant is good listening skills. Social workers may benefit from a consultant who simply listens, reflects back, and clarifies what the worker is saying. Consultants can play the role of a mirror, helping workers reflect on the situation and view the ethical issues from various perspectives.
What Are the Key Steps in Consultation?
The first step in ethics consultation is clarifying your role and the role of the consultant. What types of information will you be expected to provide? What types of help will the consultant provide? What types of help go beyond the scope of his or her consultation practice? To what extent will the consultant be able to maintain the confidentiality of the information? What are the consultant’s responsibilities if the worker discloses concerns such as child abuse; elder abuse; criminal activity; or serious, imminent harm to others? What are the consultant’s fees (if any)? Some forms of consultation are relatively informal and do not require a written service agreement, whereas some consultants may ask you to sign a service agreement.
Once you and the consultant have clarified your roles, the next step is informing the consultant about the events leading up to the ethical concerns. Bring notes to ensure you cover the main points. What are the relevant facts? This is the information that you know and is not contested. What information is in dispute, uncertain, or unknown? For instance, for the client seeking medical aid in dying, do you know how long the client is likely to live if medical aid in dying is not provided? In a conflict of interest situation, are you and the client operating on different information or assumptions about the harm incurred by the client? The consultant is in a better position to help you think through a situation if you are clear about the situation, including information that is uncertain or in dispute. Allow the consultant to ask clarifying questions. Be honest about what you know and do not know. Avoid shading the facts in a biased manner to make your conduct appear more ethical or favorable than it was.
Once you have explained the situation, let the consultant know what type of help you are seeking. Explain the nature of your predicament. If you are uncertain about the questions to ask, the consultant may help you formulate them. Are you asking for help to consider whether your past conduct has violated a particular ethical standard? If you know you have violated an ethical code, are you looking for help with what types of corrective actions to consider? Are you seeking consultation to determine how to manage conflicting ethical obligations? Are you seeking consultation about how to prepare for a professional review hearing or a mediation process related to a particular client grievance?
Be prepared to work collaboratively with the consultant. Do not expect the consultant to provide you with specific advice on what to do, but rather, what factors to consider. Be open to looking at the ethical issues from different angles. The consultant may ask the following types of questions.
- What are your primary concerns?
- What concerns do you think the client (or other stakeholder) is having?
- Which ethical standards have you considered?
- Have you looked at the standards related to…?
- What options have you considered?
- What other options could you consider?
- Who may be hurt (or helped) by each of these options?
- Which ethical principles are relevant to this situation?
- How might the principle of… apply?
Conclusion
Think of ethics consultation as a learning discussion. Consider whether you may need to gather additional information before making a final decision. Listen carefully to the consultant’s questions and suggestions. Ask clarifying questions as needed. Take notes during the consultation, so you will have a record of what was discussed and how you arrived at your decisions about how to respond to the ethical issues.
Finally, think of consultation as a safe place for testing various responses to ethical questions. You should feel free to share your thoughts and opinions, knowing the consultant is there to offer information, clarification, insight-oriented questions, and support.
Allan Barsky, JD, MSW, Ph.D., is professor of social work at the Phyllis and Harvey Sandler School of Social Work at Florida Atlantic University. He chaired the NASW Code of Ethics Review Task Force and was a member of the National Task Force on Social Work and Technology. His book authorships include Ethics and Values in Social Work, Conflict Resolution for the Helping Professions, and Clinicians in Court. He is a recipient of the NASW’s “Excellence in Ethics Award.”
[1] With thanks to Cole Porter for the phrasing of this opening, based on his song, “Let’s Do It, Let’s Fall in Love.”