10 Black and White and Gray All Over

Read the code of ethics for your particular profession. Whether you are a substance use disorder counselor, social worker, therapist, case manager, psychologist, or any other type of helping professional, you will find a substantial set of guidelines that serves as your behavioral template. The ethics code reveals the principles of the field while also spelling out the dos and don’ts of professional conduct. Do: maintain confidentiality, build on client strengths, and support the community. Don’t: discriminate in providing services, impose your values, or have sex with your clients.[1]

These rules might seem like a black-and-white set of directives that provide clear instructions for helping professionals to follow, similar to baking cookies or playing a board game. The fact is, many of our daily interactions and decisions are based on judgment calls. They are informed by our training, including ethics training, but they have to be carried out by human beings in challenging situations which may constitute gray areas.

The point of this essay is to convey how difficult it is to actually apply a code of ethics in practice. A person could memorize their code word-for-word, but when a genuine ethical dilemma arises, chances are there is no section of the code that addresses exactly what to do in that exact situation.

It is quite different to answer a test question about the right way to deal with a situation than to carry out that decision in a work setting. As one example, I ask student interns how they would handle a client who told them that she is HIV-positive and has multiple sexual partners from whom she kept her health status a secret.

This inevitably leads to hearty discussion, which quickly reveals people’s own morals and values. Students mention legal ramifications, agency policy, personal obligation. And of course, we can return to the code of ethics, which in most cases will say little if anything about how to handle this situation, other than the fact that confidentiality should still be followed.  But shouldn’t there be a duty to warn? What are the implications if we break that confidentiality? Could we lose our job or face punishment from a licensing board?

Not every decision in a helper’s day falls into this ethical gray area, but during the course of a career, some likely will. If you read my introductory story about riding a late-night train with a patient from the psychiatric hospital where I worked, then you know I am guilty of at least one ethical violation in my career. I would hazard a guess that at least a few other instances could fall into that category as well. Yet, I consider myself an ethical professional. I aspire to make a positive impact in the lives of the clients I encounter, and as an instructor, in my students’ lives as well.

The reality is that even the most ethical practitioners probably struggle at times with difficult ethical dilemmas. Remember that decision-making involves four layers:

• Legal – this is the highest level of authority and includes both state and federal laws that must be followed
• Ethical – this layer is covered by our professional code of ethics; some professionals must adhere to multiple codes based on their credentials
• Policy – the agency’s rules of conduct and procedures for various situations
• Personal – this includes our own values and morals, which are always at work

Ideally, the four layers above fall into alignment and we can be true to our values while following the agency’s policies, staying consistent with the ethics code, and respecting the law. Yet, at times we may find that something seems off, or we just aren’t sure what to do.

Should we make a call to child protective services based on what that client just said? Should I tell my supervisor if I saw one of my clients drinking at a bar over the weekend?  Is it alright to discharge a client from treatment after a managed care provider said they would no longer pay for this level of care?

Questions like these require serious consideration, as well as supervision. We should be familiar with applicable laws, our code of ethics, and our agency’s policies. Then we should do our best to uphold the aspirational ethics of the helping field and strive to provide the best possible care for our clients.

And we do that despite constraints on finances, physical space, and adequate staffing. We do our absolute best. Then we document what we did, we tell our supervisors what we did, and we move on.

When we go to bed, we may wrestle with some of these choices, but when we wake up, if we have followed these guidelines to the best of our ability, we should be able to go to work again with the knowledge that we have done the right thing, and that our decisions have helped the people we serve. No one who has worked in the helping field for any significant period of time can say that they always make the exact right choice in every situation. Human nature dictates that we are fallible and bound to make errors in judgment.