A duty to warn, an uncertain danger.

KIE: A case study is presented in which a maternity patient with a history of schizophrenia and pyromania informs a hospital social worker that she and her infant will live temporarily with a clergyman and his family. The social worker, aware of the patient's history and concerned for the family, asks the patient for permission to discuss her problems with the clergyman, but is refused. Reamer argues that the social worker has a duty to warn, should disclose no more information than is necessary, and should seek authorization from a hospital review committee. Schaffer maintains that the legal duty to warn established by Tarasoff v. Regents does not apply because neither the danger nor the therapeutic relationship are comparable. She suggests a general conversation with the clergyman on the risks of housing transients as an alternative to silence or breach of confidentiality.^ieng

Should child abuse always be reported?

KIE: A case is presented involving sexual abuse of an adolescent by her brother. The physician and social worker, consulted by the pregnant adolescent and her mother, are required by state law to report the incident to the Department of Family and Children's Services. The mother objects, fearing confidentiality will not be maintained, and argues that the family is capable of handling its own problems. The commentators, a philosopher and a social worker, discuss the options available to the health professionals and their probable consequences.^ieng

Should competence be coerced?

KIE: In this case study, a forensic psychiatric patient is advised by his attorney to avoid trial on criminal charges by refusing further treatment with drugs that are controlling his psychotic symptoms. The case raises the question of whether an involuntarily committed forensic patient has the right to refuse treatment that will restore his competency to stand trial. Reamer, a professor of social work, asks why "a manipulative tactic involving refusal of medication" should be regarded any differently from other disruptive things that criminal defendants may do to postpone or prevent a trial. Kelly, a law school dean, argues that if the patient is competent to understand the consequences of his refusal and to make decisions for himself, he "clearly has the right to refuse treatment of his psychotic symptoms to avoid trial." Unlike Reamer, Kelly believes the patient's attorney may be acting appropriately by advising his client to refuse further medication.^ieng

AIDS and social work: the ethics and civil liberties agenda.

Social workers are becoming increasingly involved in casework and social policy debate related to the acquired immune deficiency syndrome (AIDS) crisis. To enhance their delivery of services and contribution to policy formulation, social workers need to be familiar with a wide range of ethical and civil liberties issues that have been generated by the AIDS epidemic. This article provides an overview of six major ethical and civil liberties issues pertaining to social work practice related to AIDS: (1) mandatory screening and testing of clients for the human immunodeficiency virus (HIV), (2) client access to health insurance, (3) professionals' duty to treat HIV-infected clients, (4) privacy and confidentiality, (5) client involvement in AIDS research, and (6) relevant legal issues. Implications for social work practice are highlighted, particularly with respect to protecting clients' rights and formulating a social action agenda.

AIDS, social work, and the "duty to protect".

This article discusses social workers' obligations in cases where clients with acquired immune deficiency syndrome (AIDS) pose a threat to a third party. Emphasis is on cases where a client diagnosed with AIDS withholds that information from a sexual partner. Legal and ethical issues concerning the limits of confidentiality and the social worker's "duty to protect" third parties are reviewed. Relevant case law and emerging ethical standards in various professions are summarized. The author reviews legal precedents concerning disclosure of confidential information without a client's permission and discusses their relevance to AIDS cases. Implications and guidelines for social workers are outlined.

The emergence of bioethics in social work.

Ethical issues in health care, or bioethics, are not new to social work, but the maturation of the profession no less than scarce resources and advances in technology are focusing increased attention on social workers' responses to complex moral questions. A review of the history and scope of these issues provides a framework for addressing them.

Facing up to the challenge of DRGs.

Like other policies intended to check spiraling health care costs, the introduction of diagnosis related groups (DRGs) poses special risks for social work's traditional clients. This article identifies those risks and also describes the opportunities for social workers to influence the implementation of this major social welfare reform.

Enforcing ethics in social work.

The attention paid by the social work profession to ethical issues has waxed and waned since the formal inauguration of the profession in the late 19th century. For the first half century of the profession's life, relatively little attention was devoted to problems of professional ethics, though social work's literature was filled with discussions of value-laden issues that arise in practice. In recent years, interest in professional ethics has increased substantially. This article discusses the growth of interest in professional ethics, the formulation of the social work code of ethics, the adjudication of grievances in social work, and the strengths and limitations of the profession's code.

The social work ethics audit: a risk-management strategy.

In recent years, social work's knowledge base related to professional ethics has expanded significantly. However, most practicing social workers concluded their formal professional education at a time when comprehensive ethics education was not a critical or mandated component of the curriculum. This article integrates current knowledge on social work ethics and introduces the concept of a social work ethics audit to aid social workers in their efforts to identify pertinent ethical issues; review and assess the adequacy of their current ethics-related practices; modify their practices as needed; and monitor the implementation of these changes.