Eye on Ethics

Planning Ahead — Drafting a Professional Will
By Frederic G. Reamer, PhD
August 2013

Recently, I received a frantic telephone call from a clinical social worker who works in a group independent (private) practice. The social worker informed me that her longtime colleague in the group practice—also a clinical social worker—died suddenly following a heart attack. The social worker who called me posed a series of questions: Should I notify my colleague’s clients? What do I need to do to access her confidential client records to obtain contact information? Am I allowed to review my colleague’s confidential client records to determine whether there are crisis situations that need careful clinical management? What do I do with my colleague’s records? Should I refer my colleague’s clients to other practitioners or offer to serve them myself?

I asked the caller whether the deceased colleague had ever mentioned that she had a professional will. The caller responded, “What’s a professional will? I’ve never heard of that.”

Sadly, too often clinical social workers face these ethical questions in a moment of crisis, when a colleague has suddenly died or become incapacitated. Of course, no one wants to anticipate death or incapacitation, but it behooves social workers to plan for the unexpected (and unwanted) to ease the burden of surviving clients, colleagues, family, and loved ones. The best way to do this is to draft a professional will.

Key Elements of Professional Wills
A professional will enables social workers to plan for what happens if they die or become incapacitated. It spells out the steps that colleagues or other parties should take to ensure that clients’ needs are met in a timely fashion. This guidance can be particularly helpful when death or incapacitation occurs without forewarning. A comprehensive professional will should address several key issues.

• Who will assume responsibility?Social workers need to designate an individual (or individuals) who will take charge in the event of a social worker’s death or incapacitation. This may be a colleague or another trusted party. Ideally, it’s a trained professional who is familiar with ethical standards in social work pertaining to client confidentiality and informed consent.

The professional will should include detailed contact information, such as telephone numbers (e.g., landline, mobile, fax), office address, and e-mail address. It makes sense to include a backup name or two as well.

Social workers should meet with their designee to ensure that he or she fully understands the details included in the professional will. Be sure to transfer information about the location of office keys and security codes, too. Social work designees also should have information about voice mail access codes in order to review and respond to clients’ messages.

• Client records:Social workers should inform their designees about the location of clients’ physical records and filing cabinet keys. Social workers who maintain electronic records should ensure that their designees have relevant computer usernames and passwords along with information about the computer filenames where records are located.

Designees also should know how to access social workers’ schedules so that clients who have upcoming appointments can be notified. The professional will can state who should store the records until more permanent arrangements can be made.

• Informed consent and client notification:When social workers begin working with clients, they should consider obtaining clients’ consent to share their contact information and, if necessary, clinical records with the social worker’s designee in the event of an emergency. This can be included in the initial consent to provide services that social workers have clients sign at the beginning of the professional-client relationship.

Professional wills can identify specific ways that designees can notify clients of the social worker's incapacitation or death, such as calling each client, placing a notice in the local newspaper, changing the social worker’s outgoing voice mail message to include the announcement, changing the voice mail message to ask clients to call the designee who is implementing the deceased or incapacitated practitioner's professional will, and sending letters. Which notification approach is most appropriate depends on the nature of the social worker’s unique practice and clientele.

Ideally, designees who notify the social worker’s clients about his or her death or incapacitation should provide clients with information about steps they can take to arrange other services. This may include the names of other providers and their contact information. As the NASW Code of Ethics states, “Social workers should make reasonable efforts to ensure continuity of services in the event that services are interrupted by factors such as unavailability, relocation, illness, disability, or death” (standard 1.15).

Whatever forms of notification are considered, social workers and their designees should be mindful of clients’ right to privacy and confidentiality. Letters, e-mail messages, and telephone or voice mail messages that are not carefully handled can inadvertently disclose to third parties that a person is seeing a clinical social worker. This can be particularly problematic, for example, when clients are domestic violence victims who sought clinical social work services without their partner’s knowledge; unintentional disclosure to the abusive partner that the client was receiving therapeutic services may exacerbate the client’s risk. According to the NASW Code of Ethics, “Social workers should take reasonable precautions to protect client confidentiality in the event of the social worker’s termination of practice, incapacitation, or death” (standard 1.07[o]).

• Notification of colleagues, insurers, and attorneys:A professional will can identify members of the social worker’s peer consultation group who should be notified in the event of the social worker’s death or incapacitation. It also can include information about the social worker’s professional malpractice insurer, policy number, and contact information. Further, a professional will can include the name of and contact information for an attorney the social worker has used for professional consultation.

• Billing information:The social worker’s designee will need to know where billing records are located, how to access them (whether paper or electronic records), who prepares and processes the bills (eg, billing service, office clerical worker), and how pending charges should be handled.

• Expenses:Managing a deceased or incapacitated colleague’s affairs can be very time consuming. A professional will can specify how the social worker’s designee will be compensated. Options include authorizing payment of the designee a customary hourly rate, a flat fee, or a token payment. A professional will should include clear instructions about how all expenses are to be paid.

Social workers would do well to have a skilled attorney—particularly one who has expertise in health and mental health law—help prepare and review a draft of the professional will. Once the professional will has been finalized, the attorney and designee should retain copies. Social workers and their attorneys should decide whether the designees should have access to confidential information such as computer usernames, passwords, and other access information at the time the professional will is drafted or only after the social worker’s death or incapacitation. Social workers should review and update their professional wills on a regular basis (e.g., yearly).

Final Thoughts
Anticipating the possibility of incapacitation or death is not pleasant, but social workers know well how unpredictable life is, not only for clients, but for themselves as well. Thus social workers have an ethical duty to prepare in order to protect clients and ensure the continuity of services.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.