Eye on Ethics

From “Case” to “Cause” in Social Work
By Frederic G. Reamer, PhD
August 14, 2009

Darlene is an independent clinical social worker who specializes in adoption-related issues. A number of Darlene’s clients are adult adoptees who know little or nothing about their birth parents and the circumstances surrounding their adoption. Most of these clients were adopted at a time when “closed” adoptions were common; adoptees’ original birth certificates were sealed, and they were issued birth certificates listing their adoptive parents as their birth parents. As adults, many of Darlene’s clients have been eager for information about themselves, especially crucial mental health and other medical information with important implications for them and their children as they age (e.g., genetic risks).

One of Darlene’s clients struggles with clinical depression and significant self-esteem issues. The client often talks about the emptiness she feels when she thinks about her birth parents’ decision to terminate parental rights and make an adoption plan. “Why am I not allowed to see my own birth certificate? What is so shameful about my birth that the truth must be kept secret from me? Adoption is so frustrating!” the client says. Over time, Darlene became more convinced that the client would benefit from knowing basic information about her birth circumstances.

Darlene decided to share her concerns with a colleague who worked for a local adoption agency. The colleague told Darlene that a local coalition, including adoptees, adoptive parents, birth parents, and adoption professionals, was forming to contact state legislators about drafting a bill that would allow adult adoptees access to their original birth certificates. Darlene, a skilled clinician, had never been involved in legislative advocacy. She decided to attend the coalition’s first meeting and quickly realized how much she had to contribute because of her vast clinical experience.

During the next few months, Darlene attended coalition meetings and shared her insights about the clinical consequences for adoptees who do not have access to their original birth certificates. For the first time in her career, Darlene met with legislators and testified before legislative committees. Toward the end of the experience, Darlene commented to her colleague, “I finally understand what my social work professors meant when they told me that being a social worker means connecting clinical and policy issues. Now I get it.”

From Case to Cause
Students of social work history know that one of the profession’s hallmarks—since the time of Jane Addams and Mary Richmond—has been the integration of “case” (helping individual clients address and cope with life’s challenges) and “cause” (engaging in social action, advocacy, and reform efforts). In principle, social work has never been an either/or profession, focusing exclusively on clinical or reform efforts. Indeed, one of social work’s most cherished attributes is its simultaneous commitment to individual well-being and broader social concerns. Significantly, the preamble in the current NASW Code of Ethics articulates, for the first time in social work’s history, this unique mission:

The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty. A historic and defining feature of social work is the profession’s focus on individual well­-being in a social context and the well-­being of society. Fundamental to social work is attention to the environmental forces that create, contribute to, and address problems in living. Social workers promote social justice and social change with and on behalf of clients.

Some social workers—a relatively modest percentage—enter the profession primarily to work on social justice issues, typically related to poverty, unemployment, homelessness and housing, and healthcare. Most social workers, like Darlene, enter the profession to provide clinical services to individuals, couples, families, and small groups. One of the enduring challenges in social work has been ensuring that its practitioners fully embrace both case and cause, understanding the complex and essential connections between individuals’ private troubles and the public issues that surround them. As Darlene discovered, her ability to help adult adoptees who struggle with issues of identity may depend on legislative decisions about adoptees’ access to their original birth certificates.

Ethical Mandates
Social workers’ overarching duty to be cognizant of, and address, broad social concerns is addressed explicitly in several sections of the Code of Ethics. In addition to the mission statement contained in the code’s preamble, the code identifies social justiceas one of the profession’s core values:

Social workers challenge social injustice. Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. Social workers’ social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. These activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity. Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people.

In addition, the code includes several ethical standards that outline social workers’ moral duty to address social issues that affect both clients and the broader community.

Social workers should promote the general welfare of society, from local to global levels, and the development of people, their communities, and their environments. Social workers should advocate for living conditions conducive to the fulfillment of basic human needs and should promote social, economic, political, and cultural values and institutions that are compatible with the realization of social justice (standard 6.01).

Social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully. Social workers should be aware of the impact of the political arena on practice and should advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice (standard 6.04[a]).

Social workers should act to expand choice and opportunity for all people, with special regard for vulnerable, disadvantaged, oppressed, and exploited people and groups (standard 6.04[b]).

Social workers should promote conditions that encourage respect for cultural and social diversity within the United States and globally. Social workers should promote policies and practices that demonstrate respect for difference, support the expansion of cultural knowledge and resources, advocate for programs and institutions that demonstrate cultural competence, and promote policies that safeguard the rights of and confirm equity and social justice for all people (standard 6.04[c]).

Social workers should act to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical disability (standard 6.04[d]).

Both case and cause are indispensable components of social work practice. Darlene learned this firsthand.

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