Ethical Issues Addressing Spirituality in Social Work Practice Chikako Nagai, Ph.D., LICSW Assistant Professor Department of Social work California State.

Social Work and Ethics Social Work and Ethics Social Work Codes of Ethics

Laws vs. Ethics

Personal Ethics

Professional Ethics

Competency in Social Work Practice

Professional Competency

Cultural Competency

Spiritual Competency

Codes of Ethics Codes of Ethics for Spiritual for Spiritual PractitionersPractitioners

Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC)

Chaplains and Pastoral Counselors

Spiritual Guides Theological Ethical Codes

Codes of Ethics Codes of Ethics Based on Specific BeliefsBased on Specific Beliefs

Christian Code of Ethics

Native American Traditional Beliefs

Buddhist Virtues/Precepts

Islamic Laws and Ethics

Ancient Egyptian System of Values

Ethics of Hinduism

Jewish Ethics

Ethical StandardsEthical Standards

Development of Ethical Standards Personal and Professional Standards

“Low” and “High” Standards Cultural and Spiritual Standards

Ethical Worldviews Ethical Worldviews (Shweder, 1999)(Shweder, 1999)

1) Ethical Universality, Ethical Relativism, and Ethical Hedonism

2) Ethics of Autonomy, Ethics of Community, and Ethics of Divinity

3) Cultural/Spiritual Blindness and Cultural/Spiritual Consciousness

4) Cultural/Spiritual Dominant Views and Universal Human Rights

Ethics and Ethics and PostmodernismPostmodernism Multiple Realities & Multiple Interpretations

Social Constructivism

Intersubjectivity

Subjectivities and Ethical Views (Shweder, 1999)

1) denier

2) implicit minimizer

3) explicit imposer

4) implicit imposer

5) explicit minimizer

ExerciseExerciseSmall Group/Class Discussion Small Group/Class Discussion

Identify various ethical and spiritual views, interpretations, and meanings.

1) Animal Sacrifice

2) Use of Substance for Religious Practice

3) Use of Conversion Therapy for Gender Identity Disorder

4) Gay Marriage and Related Rights

5) Limiting Medical Procedure such as Blood Transfusion

Spirituality in Spirituality in Social Work Practice Social Work Practice Definitions: Spirituality and ReligionPrevalence: Spiritual Practice Gap: Social Workers and

Consumers

Question: How do the above issues influence our social work practice?

Spiritual Counseling Spiritual Counseling MovementMovement Historical Views

First Force Second Force Third Force Fourth Force Fifth Force

Theoretical Views Psychodynamic approaches Cognitive and Behavioral approaches Humanistic approaches Multicultural approaches Spiritual approaches

Assessment Assessment Diagnosis (DSM IV TR – Spiritual and

Religious Problems, Culture-Bound Syndromes)

Spiritual Emergency vs. Emergence (Grof & Grof, 1989)

Psychosis vs. Spiritual Experiences

Spiritual Crisis vs. Spiritual Growth

Helpful vs. Harmful Spiritual Practice

Spiritual Assessment Spiritual Assessment ToolsTools Hodge (2003) Hodge (2003)Spiritual Genograms Spiritual Lifemaps Spiritual Eco-maps Spiriutal Ecograms

Spirituality is one of the Spirituality is one of the most important aspects of most important aspects of

diversity.diversity.

Why do we often neglect or overlook spirituality in social

work practice?

Ethical ConcernsEthical Concerns

1. Fear of failing to serve as a blank slate (Ridley, 1995)

2. Dominance of a one-person psychology and positivistic belief in science (Mitchell, 1988; Walsh, 1998)

3. Anxiety regarding violations of professional ethics and laws (Boorstein, 1997; Steen, Engels, & Thweatt, 2006)

Ethical ConcernsEthical Concerns

4. Apprehension or doubt about political correctness (Gardenswarz & Rowe, 1998)

5. Ambivalence with identity of spiritual self due to a lack of training and supervision (Bullis, 1996; Canda & Furman, 1999)

6. Inadequate attention to “spiritual drive” and experiential “being” (Epstein, 1995; Fromm, 1960; Jerry, 2003; Suzuki, 1960)

Ethical DilemmaEthical Dilemma (Svare, Hylton, & Albers, 2008) (Svare, Hylton, & Albers, 2008)

Dual relationshipRole confusionValue impositionNegative spiritual

transference and countertransference

Developmental ModelsDevelopmental Models

• Religious and Spiritual Development (Oser, Scarlett, & Bucher, 2006)

• Moral Development (Gilligan, 1977; Kohlberg ,1973; Rent, 1984)

• Faith Development (Fowler , 1996)

• Ego Development (Irwin, 2006; Welwood 2000)

Discussion Questions Discussion Questions

What are the strengths and limitations of the developmental models?

How do the developmental levels of social workers and consumers influence their working relations?

How does the spiritual development relate to the ethical decision making process?

Ethical Principles Ethical Principles ((Lowenberg & Dolgoff, 2000)Lowenberg & Dolgoff, 2000)

Protection of lifeEquality and inequalityAutonomy and freedomLeast harmQuality of lifePrivacy and confidentialityTruthfulness and full disclosure

Ethical Decision-Making Ethical Decision-Making Model Model ((Lowenberg & Dolgoff, 2000)Lowenberg & Dolgoff, 2000)

1) Identify the problem and factors maintaining the problem;

2) Identify all person, groups, organizations involved in the situation;

3) Determine who should be involved in the decision-making;

4) Identify values involved in the situation – client, family, worker, professional, group, institutional, societal

5) Identify the goals and objectives which may resolve or reduce the problem;

6) Identify alternative interventions to reach the goals;

7) Assess the effectiveness of each of these alternative strategies; and;

8) Select a strategy (Group Presentation)

Case Study ICase Study I You have received a referral from the

Child Protective Service (CPS). According the CPS report, a 5 year old U.S. born Hmong girl was taken away from the family due to child neglect. The child was taken to the hospital for having a symptom of epilepsy, but the family took the child back to their home without the doctor’s permission, and changed the child’s name without a formal procedure. The child was found at home when the police was called by the neighbor for slaughtering a pig in the yard.

Small Group Small Group Discussion Questions Discussion Questions

1) How would you understand the situation?

2) How would you engage with the family?

3) How would you intervene?

Case Study I – con’tCase Study I – con’t

“The Spirit Catches You and You Fall Down” (Anne Fadiman, 1997)

Small Group Small Group Discussion Questions Discussion Questions

1) How would you understand the situation?

2) How would you engage with the family and community?

3) How would you intervene?

Social Work ImplicationsSocial Work Implications Child Neglect vs. Traditional Healing

Practice

Medical Treatment vs. Soul Treatment

Legality on Beliefs and Actions

Subjective and Universalistic Views of Both Consumers and Helping Professionals

Use of Cultural/Spiritual Empathy

Use of Cultural/Spiritual Broker

Use of Cultural/Spiritual-Self

Use of Self-Disclosure on Spiritual Beliefs

Case Study IICase Study IITerri Schiavo, a Floridian who was in a

vegetative state since 1990, had her feeding tube removed in 2005. Her husband had won the right to take her off life support, which he claimed she would want but was difficult to confirm as she had no living will and the rest of her family claimed that Schiavo was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by refusing nutrition and hydration.

Small Group Discussion Small Group Discussion In 2004, Pope John Paul II stated that

health care providers are morally bound to provide food and water to patients in persistent vegetative states.

Question: How would you advocate for the consumer, family, and/or community?

Social Work ImplicationsSocial Work ImplicationsReligious Beliefs, Family’s Wish, Self-

Determination, and Protection of Life

Individual Right vs. Religious Interest and/or Societal Intervention

Consumer/Legal Guardian's choice vs. Consumer’s Life

Advanced Directives

Death with Dignity Act (1994) & Washington Initiative (2008)

Case Study IIICase Study III

You supervise a state employee who plans a public health care event in the state building. He asks a consultation from you if he could allow religious groups along with other public agencies display their services at the event.

Discussion Question: How would you advise your staff as a supervisor?

Social Work ImplicationsSocial Work Implications

Sherbert and Lemon Tests:

Were other religious and political groups also invited?

Did the event advance or inhibit any particular belief?

Was the state’s interest compelling?

Questions

and

Comments

Thank you very much