Eye on Ethics

The Concept of ‘Choice Architecture’ in Ethical Decision Making
By Frederic G. Reamer, PhD
November 6, 2012

Perhaps you are familiar with the book Nudge by University of Chicago scholars Richard Thaler and Cass Sunstein. The premise is that the quality of individuals’ choices about things such as investments, food, education, and environmental protection is influenced by “choice architecture.”

Thaler and Sunstein define choice architecture as the way in which decisions are influenced by how choices are presented. They claim that three key features of choice architecture are default, giving feedback, and expecting error. Default is what happens if someone does nothing; feedback shapes choices; and expecting error when making choices can lead to the creation of effective backup plans and safeguards.

So what does the concept of choice architecture have to do with social work ethics? Although Thaler and Sunstein did not write for or about social workers, their framework has much to teach us about how we make, or should make, ethical decisions.

Consider, for example, Tanya, a social worker who provides counseling services to Dylan, an adolescent client who struggles with mental health issues. During the course of their work together, Dylan discloses that he has been abusing substances, including ecstasy and crystal meth.

Tanya is eager to supplement her counseling services by enrolling the teen in her agency’s new federally funded program designed to treat adolescents who have co-occurring challenges (mental illness and substance abuse). Dylan is eager to enroll in the supplemental program but refuses to give permission for Tanya to inform his parents about his substance abuse.

The Default Option
The ethical dilemma, of course, involves conflict between Dylan’s confidentiality rights and Tanya’s duty to inform his parents about their child’s treatment and health risks. According to choice architecture, the social worker should consider the consequences of default—what would happen if she does nothing, the path of least resistance. In principle, this would mean that Dylan would not receive the additional services her agency has to offer, which may not be in his best interest. This course of action would protect the minor’s confidentiality rights but deprive him of potentially valuable clinical services (unless state law permits social workers to provide these services without parental notification and consent).

Doing nothing is fraught with risk in social work ethics. Indeed, the National Association of Social Workers' Code of Ethics states that “ethical decision making in a given situation must apply the informed judgment of the individual social worker and should also consider how the issues would be judged in a peer review process where the ethical standards of the profession would be applied.” Doing nothing is unacceptable; social workers must face challenging ethical dilemmas head on.

Giving Feedback
The concept of giving feedback in choice architecture suggests that the quality of social workers’ decisions can be enhanced when feedback mechanisms are part of the process. This is consistent with social workers’ longstanding instinct to seek collegial consultation when faced with difficult decisions. Indeed, the Code of Ethics states that social workers “seek appropriate consultation when faced with ethical dilemmas. This may involve consultation with an agency-based or social work organization’s ethics committee, a regulatory body, knowledgeable colleagues, supervisors, or legal counsel.”

Ideally, earnest consultation would provide Tanya with constructive feedback about the potential consequences of various choices she might make regarding the minor client’s confidentiality rights and her duty as a social worker to share treatment-related information with the parents.

Expecting Error
Ethical decisions, like most decisions, are often made with incomplete, imperfect information. Ideally, no facts would be missing or fuzzy. Social workers would be thoroughly familiar with relevant ethical standards and laws, for example, regarding minors’ rights to confidentiality, consent for services without parental notification, and parents’ rights. To protect clients and third parties and minimize risk, social workers who face difficult ethical decisions would do well to anticipate the possibility of error and build checks and balances into their decision-making protocols.

What sorts of checks and balances can minimize error and enhance the likelihood of sound decisions? In my experience there are several essential ingredients:

• Identify the ethical issues, including the social work values and duties that conflict.In this case, the teen’s right to privacy and confidentiality conflicts with the parents’ right to know about Dylan’s health-related risks and the social worker’s duty to inform the client’s parents about treatment options.

• Identify the individuals, groups, and organizations likely to be affected by the ethical decision.These include the minor client, his parents, the social worker, and the social worker’s supervisor and agency administrators. If Tanya shares confidential information with Dylan’s parents without his consent (or what is often called assent in the case of minors), Dylan may feel betrayed; this could jeopardize his clinical relationship with Tanya and his therapeutic progress. However, if Tanya decides to withhold this information from Dylan’s parents and they learn about it subsequently (perhaps because Dylan chooses to disclose it or a third party “leaks” this information), Dylan’s parents may be so upset that they file a licensing board complaint against Tanya or a lawsuit against her, her supervisor, and the agency.

• Tentatively identify all viable courses of action and the participants involved in each, along with the potential benefits and risks for each.This requires thorough examination of each option—primarily protecting Dylan’s confidentiality or disclosing it without his permission—and the potential impact, both positive and negative, of each option.

• Thoroughly examine the relevant reasons in favor of and against each course of action.

- Codes of Ethics and legal principles: The Code of Ethics includes several relevant standards pertaining to commitment to clients and clients’ rights related to self-determination, informed consent, and confidentiality and privacy (see sections 1.01, 1.02, 1.03, and 1.07).

- Ethical theories, principles, and guidelines: In recent years social work ethics scholars have developed conceptual protocols designed to apply well-known ethical theories, principles, and guidelines to complex cases. These include what moral philosophers call deontology, teleology, utilitarianism, virtue theory, and ethics of care, among others.

- Social work practice theory and principles: Over the years social workers have developed rich clinical protocols and frameworks that may be helpful when working with a struggling teen who is reluctant to share sensitive information with his or her parents.

- Personal values (including religious, cultural, and ethnic values and political ideology), particularly those that conflict with one’s own: Social workers should always examine their own biases that may influence their professional judgment.

- Consult with colleagues and appropriate experts (such as agency staff, supervisors, agency administrators, attorneys, and ethics scholars): Diligent consultation provides useful checks and balances when social workers make difficult ethical judgments.

- Make the decision and document the decision-making process: Careful documentation enhances the continuity of services and, as well, serves to protect social workers in the event that anyone raises questions about their judgment and decision-making process.

The dictionary defines nudge as “to touch or push gently” and “to push into action.” In their book, Thaler and Sunstein wisely remind us how risky it is to do nothing in the face of a challenge, how essential meaningful feedback is, and how important it is to take steps to minimize error when making decisions. Let this be a constructive nudge in the direction of sound architecture in ethical decision making.

— 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.