Social work is a profession with a history in supporting the dispossessed and poor people. The profession works with policies intended to safeguard the rights of individuals in these categories. Burson (2007) explained that the duties of social workers include availing of services, information, and other relevant resources. They also ensure that people get equal opportunities and play significant role in making of decisions. In summary, social work is a profession that encourages social transformation, solves problems within human relationships, and empowers people to improve their wellbeing.

For this reason social justice and human rights are essential principles. Ethical tension in social work, thus, results from the need to respect individual rights while following the diverse cultural aspects. McAuliffe (2005) argued that ethical dilemmas are inevitable in social work. There is thus a need for better education and training of professionals in the area of ethical decision-making. This article analyses the application of ethical decision-making to solve the dilemma in the situation of Paul Jones and his wife, Louise Jones.

Impact of Professional and Organisational Environment

In the professional environment, Miranda Smith has acted in the interest of Louise by sharing her confidential information. The disclosure is in Louise’s interest because Smith’s intention is to obtain support in improving safety of the client. With this disclosure, I now know the difficulties that Louise will face if Paul stops going for the counselling sessions. The presented opportunity must now be utilised to contribute towards preservation of Louise’s right to life, health and safety. The desirable outcome will be attained through actions that can prevent Paul from harming his wife.

Organisational Environment

The community health centre’s observance of stewardship is problematic to the couple’s situation. Harrison and Taylor (2016) argued that stewardship is the value which drives attainment of sustainable funding, thoughtful allocation of resources, and setting of limits. In this regard, the community centre has reduced the number of sessions available to clients as a way of coping with funding and recruitment challenges. This has increased the possibility of ending Paul’s counselling services.

With termination of counselling, however, the arguments between Paul and his wife over gambling as well as domestic violence are likely to worsen. Services offered at the community centre have had significant positive effect on Paul’s condition. His health records showed resolution in his suicidal ideation and decrease in gambling. Louise also testified that her husband’s behaviour improved since the commencement of the counselling sessions. This good progress will be altered by the premature termination of support from the community centre.

Relevant AASW Code of Ethics Principles and Sections

Australian Association of Social Workers (2002) stated that social workers should only utilise confidential information to accomplish the purpose that necessitated its acquisition. The client’s consent is, therefore, required before using the provided information for a purpose that has direct relation. The permission to use the client information may also be sought through lawful excuses like statutory requirements. Even with the authorisation, a social worker can only share confidences with appropriate individuals. The disclosures should be done with client’s informed consent or in his/her presence.

AASW (2015) also indicated that Code of Ethics 5.2.4b requires social workers to tell their clients about potential confidentiality limits, reasons for gathering and using the information, and individuals that may access the information. On the other hand, Code of Ethics 5.2.4e allows for disclosure without consent. However, the social worker has to be sure that such a breach of confidentiality will prevent a known risk of harming another individual (AASW, 2015). Section 5.2.4f adds that a social worker may withhold the information about disclosure if additional risks may result from informing a client about it.

Approach to the Situation using Own, Organisational Values and AASW Code of Ethics

Based on my value of honesty, I would tell Miranda Smith to inform Louise about the need and benefits of disclosing the confidential information she offered. Braunack-Mayer and Mullingan (2003) explained that ethical implications need to be carefully evaluated if the patient information is to be shared without their awareness.  They added that ethics of any disclosures can only be verified after considering clients’ autonomy/interest and the interest of public in either keeping or violating confidentiality. The authors emphasised the importance of offering patients adequate information about the possible sharing of their details. This preserves the autonomy of the patient and also avoids ethical issues. 

Thomson (2000) also stated that there is a common legislation in 1997 Health Records Act (in Australian Capital Territory), the 1998 Privacy and personal Information Protection Act (New South Wales, and the 2001 Health Records Act (Victoria). That is, the relationship between doctors and patients is founded on significant disclosure on how the provided information will be used. The duty extends beyond keeping of promises on maintenance of confidentiality and avoids any assumptions in formation of trustworthy relationships.

When patients are aware of the way in which their information will be utilised, the outcome is trust and delivery of proper healthcare. In a different study, Tyrer, Seivewright, Ferguson and Johnson (2003) examined the ethics concerning cold calling or visiting of clients without any agreed upon appointments. This practise is in some way related to sharing of client information without consent. They found that consent procedures were required to justify the ethical basis of the practice.

Organisational Values

With reference to the organisational duty of care, I would accept the disclosure without consent and continue Paul’s sessions to improve safety of Louise. Although this violates the organisational value of confidentiality, the shared information is not very sensitive. Thus, a ‘one fits all’ framework might be too blunt to apply in resolving the dilemma (Kent, 2003). Also, disclosure of the less sensitive details enable performance of deductions about other members of the concerned family.

Kent (2003) argued that medical details are not equally sensitive. Treating all information as confidential thus hinders beneficial usage. The author added that an absolute confidentiality right does not exist and some information has to be shared to avoid significant professional and patient problems. Tyrer, Seivewright, Ferguson and Johnson (2003) also reported that physicians divert from ethical directives when need arises. Clark (2006) argued that standard ethical codes are by themselves inadequate in resolving conflicts encountered in social work.

From a different perspective, this breach of confidentiality and privacy policy illustrates that Miranda Smith is professionally competent. Melamed, Fromer, Kemelman and Barak (2000) argued that it is alright for the psychiatrist to develop a sense of responsibility towards the mentally ill client. The psychiatrist should also allocate adequate time to form a relationship with the patient. This extends the treatment process and allows for precise assessment that enables appropriate treatment of the mentally ill individual. Melamed et al. suggested that while talking with the mentally ill patients, psychiatrist should gather crucial details regarding the families to which they belong and how they lived in the past. The information may allow reconnection of the patients with people from their past and ensure that their differences are settled.

Thomson (2000) stated that keeping full information of a patient secret is not the duty of a medical practitioner. The actual duty is to utilise the provided pieces of information for the purpose that prompted its collection. In the case, the information about Louise was clearly disclosed for the purpose of explaining the reason why Paul’s counselling services should be continued. In other words, Smith used the information for clarification of diagnosis, confirmation of treatment decisions and for search of additional assistance in solving Louise’s problem.

Therefore, these uses did not violate the common-law duty regarding confidentiality. Additionally, there is suggestion that such disclosure would reasonably avoid or minimise a serious threat to safety, life and health of the client. Smith explained that Paul could access weapons within their property and harm Louise. Even more, the continued argument between the husband and wife could easily trigger violence. The disclosure thus complies with the terms of the 1988 Privacy Act.

AASW Code of Ethics

The AASW ethics code permits disclosure in circumstances similar to that of Jones family. In other words, section 5.2.4e authorises disclosure without consent in cases where the primary objective is to avoid harm on a particular individual (AASW, 2015). Miranda Smith shared the information because she was extremely worried about the safety of Louise.

The case reports that weapons were easily available for Paul and he could easily harm his wife given that they keep arguing about his gambling problem. The practice also complies with section 3.1 of Code of Ethics (2010) which is based on respect for persons. The Code explains that provision of humane services, dedication towards fulfilling duty of care and avoidance of harm to others are responsibilities of social work.

The disclosure is as well in line with social justice (section 3.2) as it is intended to encourage social fairness and justice by eliminating barriers of access to counselling services for Paul. Although the community centre has funding and recruitment issues, Paul has exceptional needs and assisting him is directly linked to protecting Louise’s right to safe living.

In relation to professional integrity (section 3.3), it is acceptable for social workers to utilise their skills and knowledge in areas where needs of others outweigh personal gains (AASW, 2010). Smith also fulfilled the responsibilities that Code of Ethics expects social workers to meet. That is, in fulfilment of section 5.2.1a, Smith prioritised the best interests of Louise with due concern for the respective interest of Paul. Section 5.2.1d also instructs social workers to collaborate with other professionals or service providers to serve client’s interest.

Relation between Personal and Professional Values

Although I do not place other people’s needs above mine every time, I share in the Code of Ethics’ value of service in that I use my knowledge and skills to address social evils while helping others. This means that I would assist Louise to achieve justice and safety in the stay with her husband. With this, she will not have to leave her marriage given that she used her inheritance to construct a house on Paul’s land. In relation to section 5.1.3, social justice (AASW, 2010), I believe it is appropriate to advocate for the oppressed or disadvantaged. I know that harassment, violence and other kinds of injustices violate human rights. I would gladly help Louise solve her problems. The value of dignity and worth of a person also matches my belief in empowering other people so they can address their needs and enhance their situations. The services offered at the centre empowered both Paul and Louise.

I also value human relationships and support the idea of connecting individuals that require assistance with relevant partners or organisations. In the case study, however, Smith did not (directly) connect Louise to the person who would help her address her marriage problems. The principle of integrity promotes trustworthiness, and I understand it requires honesty and responsibility. Although the act of disclosing Louise’s information showed responsibility on Smith’s part, not seeking Louise’s informed consent appears dishonest. This is especially because no risks would result from connecting her with the person who offers counselling services to her husband. As a matter of fact, working closely with Louise would improve diagnosis and treatment of Paul as she would reveal other hidden yet crucial details concerning her husband’s health and conduct.

My Possible Action before undertaking Studies in Ethics

Without studying ethics, I would not have known that a social worker has the duty of deciding the value to prioritise whenever ethical values conflict (section 4 of Code of Ethics (AASW, 2010)). Given that the community centre adheres to a code of ethics in which both importance of duty of care and confidentiality must be upheld, it would have been difficult to select the value to prioritise. On one side, the improvements witnessed so far prove that there has been no negligence in handling Paul’s case.

Besides, Louise would not sue me for negligence if I stop counselling Paul because I do not owe her a duty of care. On the other hand, the community centre values confidentiality and a breach of this would be unprofessional. If I had no idea that social workers should align the law with directives of the organisation, I would terminate the services offered to Paul. The outcome would be increased risk of harm on Louise.