Eye on Ethics

Disruptive Developments and Social Work Ethics
By Frederic G. Reamer, PhD
November 2016

The subject of professional ethics is very humbling. For example, when I became a social worker in the 1970s, HIV/AIDS had not been identified. A handful of years later, social workers and other professionals scrambled to identify pertinent ethical issues and develop sound ethics guidelines related specifically to HIV/AIDS: "Is it ethical for a professional to refuse to treat a client or patient diagnosed with HIV/AIDS? How do we protect people who test positive for HIV from workplace discrimination? Does a social worker have an ethical duty to respect an HIV-positive client's confidentiality when the social worker suspects that the client is engaging in unprotected sex with another client who does not know about the HIV?" Soon after HIV became known in the early 1980s, these ethical issues became the focus of scholarly analysis, discussion, and debate.

Here's another example: When I became a social worker there was virtually no discussion of practitioner impairment. The concept did not appear in social work's code of ethics and there was no in-depth discussion in the profession's literature. Now the NASW Code of Ethics highlights the issue and social workers' ethical responsibilities, and the topic is discussed in the profession's literature.

The key point is that we should not be complacent about ethical challenges in social work. Some issues—such as questions about the ethics of social workers becoming friends with former clients, sharing personal information with clients, and managing boundaries when social workers and clients live in small and rural communities—have been around a long time and are not going away. However, other ethical issues in the profession were unimaginable when most of us started our careers, much less when social work got its formal start in the late 19th century.

The Nature of Disruptive Developments

Recently it occurred to me that the concepts of disruptive developments and innovation are useful ways to understand the evolution of social work ethics. In the technology world, a disruptive innovation is one that displaces an existing technology and shakes up the industry or creates a new industry. With regard to social work, the advent of apps designed to help clients cope with depression and addiction, online portals that enable clients to access their clinical records at any time, video teleconferencing, and short message service (SMS) technology that allows social workers and clients to connect without ever meeting in person, and cloud computing technology that enables social workers to store sensitive client records without paper files or in-house computer infrastructures disrupted longstanding ethical standards and led to innovations. Because of this impressive disruption, at this very moment groups of social workers are developing new ethical, regulatory, and practice standards pertaining to social workers' use of technology.

The concept of disruptive innovation and technology emerged in the 1990s. Harvard Business School professor Clayton Christensen, DBA, introduced the term "disruptive technology" in his 1997 book The Innovator's Dilemma: When New Technologies Cause Great Firms to Fail. Christensen separates new technology into two categories: sustaining and disruptive. Sustaining technology relies on incremental improvements to an established technology. Disruptive technology is much less developed and often has performance problems because it is new, appeals to a limited audience, and may not yet have a proven practical application. Examples of noteworthy disruptors are personal computers, which disrupted industries that created typewriters and mainframe computers; cellular or mobile telephones, which disrupted the fixed-line telephone industry; online discount retailers, which disrupted brick-and-mortar stores; and freestanding retail medical clinics, which disrupted doctors' offices. In each instance, the traditional industry, technology, or practice was forced to evolve or face significant downsizing or extinction.

By way of analogy, ethical standards in social work have had to adapt to various disruptions in the profession itself and the broader society. The first NASW Code of Ethics, adopted in 1960, was one page long. By the 1970s, there was widespread recognition that times had changed and that the code needed serious revision if it was going to offer meaningful guidance and avoid the dustbin. The Civil Rights Movement that was so influential in the 1960s, the emergence of the bioethics and professional ethics field in the early 1970s, emerging recognition of the importance of concepts related to confidentiality and informed consent, and other factors led NASW to create a much more detailed and nuanced ethics code that was adopted in 1979.

And then there was more disruption. Between the 1970s and early 1990s social workers began wrestling with novel and unprecedented ethical issues, such as those arising out of the HIV/AIDS pandemic. The famous Tarasoff decision by the California Supreme Court disrupted social workers' thinking about clients' confidentiality rights, especially when disclosure of confidential information without clients' consent to protect a third party from harm seemed compelling. The famous Karen Ann Quinlan case, which introduced profoundly complex ethical issues about patients' right to die, led to the invention of formal ethics committees. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974–1978) and the Presidential Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1978–1983) created even more disruption in the professional ethics world, leading to newer and more comprehensive ethics guidelines and standards.

These and other developments led to the second major rewrite of the NASW Code of Ethics. The 1996 code, which is the foundation of today's NASW code, introduced a wide range of new ethics concepts that had not been addressed in the predecessor codes, especially related to confidentiality, conflicts of interest, boundaries, dual relationships, and practitioner impairment and ethical misconduct.

Responding to disruptive developments is not always easy. Some disruptions are destructive. But disruptions also can lead to constructive change, as they have with the development of ethical standards in social work.

Disruptions are hard, if not impossible, to forecast accurately. Early in my social work career I did not anticipate, and could not have anticipated, many of today's ethical challenges in the profession. This has taught me a big lesson: With regard to ethics, do not become complacent, anticipate that disruptions in the profession are likely and hard to forecast, and be prepared to innovate and calibrate our ethics-related understanding and standards accordingly.