Ethical Challenges: Profession Prepares to Protect Social Workers Amid Changing Political Landscape

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By Alison Laurio

Search online for “Planned Parenthood and abortion rights” and a page opens with large white letters standing out against a dark background. The message: “The U.S. Supreme Court has ended the federal constitutional right to abortion — handing our power to control our own bodies to politicians.”

After Roe was overturned on June 24 last year, and lacking a federal policy, many states scrambled to either protect access to abortion or ban it. Several months later, the Kaiser Family Foundation published information on the status of access to abortion, including: Abortion banned in 13 states; abortion ban temporarily blocked making abortion legal in five states; abortions available in 24 states and Washington, D.C. “Access to safe legal abortions,” Kaiser states, “now depends on where you live, and the national divide in access to abortion care has been intensified.”

Laws and regulations have been altered or new ones passed as states craft and implement legislation that protects or criminalizes women’s health care — and in some cases its providers — if abortion services are given. Also at risk as some state legislatures flex their muscles are gender identity services. Social workers in some parts of the nation are navigating ethical dilemmas and many worry they could face civil or criminal situations just for doing their jobs.

Ethics Guide

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“Regrettably, social workers in a number of jurisdictions throughout the United States are facing daunting ethical challenges in light of recent court rulings, state statutes, and governors’ executive orders,” said Frederic G. Reamer, PhD, a professor in the graduate program at the Rhode Island College School of Social Work in Providence.

“Some laws — especially those related to reproductive health and gender identity and sexual orientation — have placed social workers firmly on the horns of an ethical dilemma. Social workers who are deeply committed to serving their clients’ needs now find themselves facing onerous repercussions if their actions violate the law,” he said.

Reamer, chairman of the task force that wrote the current NASW Code of Ethics and who serves on the Code of Ethics Revisions Task Force, said for example, “Social workers who assist a pregnant person who is making a difficult decision about the pregnancy could be at risk of prosecution or other sanctions if their actions violate state law. The same is true of social workers who provide good-faith services to minor clients who seek help managing challenges related to gender identity or sexual orientation.”

Reamer said in recent months he has encountered many social workers determined to honor core social work values and assist vulnerable clients in spite of possible professional and personal risks.

“These are practitioners who embrace the inspirational statement in the NASW Code of Ethics that ‘social workers elevate service to others above self-interest.’ These are noble instincts,” Reamer said. “Every social worker who faces these difficult choices must make a decision of conscience about meeting clients’ needs in the face of possible professional and personal peril. As the Code of Ethics states, ‘Instances may arise when social workers’ ethical obligations conflict with agency policies or relevant laws or regulations. When such conflicts occur, social workers must make a responsible effort to resolve the conflict in a manner that is consistent with the values, principles, and standards expressed in this Code.’” Reamer said there are some ways social workers could protect themselves and their clients.

One practical way to protect both when assisting with a politically charged issue is to be “relatively vague in their clinical documentation,” he said.

“The reality is that social workers’ records may be accessed by third parties in a variety of circumstances — for example, in response to subpoenas and to comply with a court order.” So, social workers can state “they assisted the client with ‘a health issue’ or a ‘health-related decision’ rather than a decision related to abortion or gender transition.”

“On a broader scale,” Reamer said, “social workers can engage in zealous advocacy to challenge laws and public policies that violate core social work values.”

“Social workers throughout the United States have become energized and emboldened as a result of recent troubling efforts to weaponize and criminalize reproductive health, gender identity, and sexual orientation issues. In the long run, social workers’ efforts may serve to protect clients and themselves if they result in meaningful statutory, regulatory, and policy change.”

And that is one of the obligations the profession must take on, he said. “One of social work’s principal hallmarks, embedded prominently in the NASW Code of Ethics, is its simultaneous commitment to individual well-being and social justice,” Reamer said. “No other helping profession is as clear about this unique mission. Social workers have a long tradition of both ‘case’ and ‘cause’ advocacy — advocating on behalf of individual clients, when necessary, and engaging in the public policy arena to seek macro-level change that affects vulnerable people.”

“Social workers who embrace a truly ‘generalist’ perspective are uniquely positioned to use their voices to challenge injustice, consistent with the time-honored proclamation in the NASW Code of Ethics: ‘Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people.’”

Speaking Up

NASW Virginia Chapter staff are not staying silent. Kristin Clarke, chapter communications, spoke during an Oct. 27 Equality Virginia rally, WTVR News reported. Clarke said requiring school educators to tell parents when their child requests a change in gender identity, name and pronoun or school bathroom use “is harmful to transgender, nonbinary and gender nonconforming youth.”

“While we respect a parent’s desire to keep updated on important academic issues of their children, we as social workers do not support forced outing of a transgender student due to high risk for mental health and physical safety. Social workers, including those that are in schools, operate under a professional code of ethics that demands we advocate against discrimination of all kinds. We witness firsthand the daily impacts of harassment, violence and familial rejection of youth, especially those who are LGBTQ.”

Clarke’s comments followed a column penned by NASW Virginia Chapter Executive Director Debra Riggs, which was published Oct. 7 on the front page of the Richmond Times-Dispatch. In the column, she wrote that Virginia Gov. Glenn Youngkin’s proposed policies “to reverse protections for the state’s thousands of transgender students in K-12 public schools seriously threaten the physical and mental well-being of these children.” (Link to the full column is at end of article under “Resources.”)

Rights Codified

NASW-New Jersey Executive Director Jennifer Thompson arranged a presentation for the chapter featuring Reamer. She said he could provide and continue a much-needed conversation so members “have a legal repository” and “know what we can do, what we should do and what the considerations are. It’s important for social workers to have that knowledge.”

“The profession of social work and the values we hold are under attack,” Thompson said. “It’s incredibly vital to understand what’s at risk and prepare our social workers to navigate the system as best we can—and as some social workers work across state lines. Our goal was to start the conversation, to start people thinking how they can better do things.”

New Jersey Gov. Phil Murphy had on Jan. 13 signed a bill codifying the right to an abortion into state law, “dubbed the Freedom of Reproductive Choice Act,” a local news source noted.

“First and foremost,” Thompson said, “a lot of our social workers are grateful we live in a state that’s safer than many others. It’s easier to be a social worker when you know your state is not putting up barriers on what you do.”

Some workarounds are available. For example, she said, a telehealth session might be protected, but phone records are not. However, phone users can go into their own phone’s systems and delete some data because structures can be created “that can proactively protect your clients.”

Social workers across the country want to come together and support their communities in all states, Thompson said. “I think there’s a desire for a collective movement to support one another. Our social workers say, ‘What can we do to help support social work?’ We have to use our access and services to help others.”

Ban Triggered

Immediately after the U.S. Supreme Court announced it had overturned Roe v. Wade, Missouri Attorney General Eric S. Schmitt acted on the state’s trigger law and signed an abortion ban into law.

It created a Class 4 felony charge for medical providers with a sentence of five to 15 years in prison, said Cassie E. Brown, executive director of NASW’s Missouri Chapter.

“The law has a stipulation that the people seeking the abortion can’t be charged,” she said. “The only exception is a medical emergency that’s life threatening for the mother — irreversible impairment of life or limb of the mother.”

“Our members expressed immediate outrage, fear and concern from the moment that law went into effect. They expressed concern that clients’ lives may be in danger. It’s a potential killing effect on the social work profession, as social workers do their job in compliance with our ethical obligations while fearing that they don’t know what might come next.”

There were a wide range of reactions, Brown said.

Some members expressed that Missouri has many conservative clients who they must work with and those social workers are wondering how openly they can express their opinions. “Some fear job loss, and I’ve heard more social workers say they have a commitment to protecting bodily autonomy,” she said.

Many have talked about fears of seeing regression, and some see or are fearing a move backward as they see rights being taken away from people, which affects safety and dignity. Some social workers recognize speaking out is a privilege, Brown said, and they’re proud of the profession, proud of the way they serve clients and live our values where they are.”

Although Brown has not seen any laws passed restricting care for sports participation of trans youth, she expects the chapter will be working very hard to protect those issues in the next state legislative session. And she believes it will “take up a lot of energy based on the number of bills pre-filed already.”

“It is very important to our members,” Brown said. “We respect trans rights. Trans rights are human rights. It’s an oversimplification to say there is no interest in the state to support LGBTQ rights. It’s something those of us who feel passionate about need to move our energy toward all the time.”

Before the next legislative session begins, she said, the chapter’s plan is to engage a lobbying team of members and others; teach them needed skills, including how to best access bills and legislators; and help them learn how to push policy changes.

“We want to create a good, involved citizenry, partner with other organizations’ members on different issues, and support other organizations on several issues,” Brown said. “With a group, you can do what an individual cannot do.”

She said chapter members are both determined about and comfortable with expressing opinions on legislation, and “it shows our social workers really have a passion for policy and advocacy.”

After the late November mass shooting at Club Q, an LGBTQ nightclub in Colorado Springs, Brown said she put out a statement to membership stating solidarity with the LGBTQIA+ community and the Colorado Chapter, “expressing my personal sadness as an openly queer person to see something like this happening again.”

“I was moved by the number of members who responded to express their support to the comments and to me and to clients who experience violence as a part of their lives or is personal to them because of their identities.”

“Social workers are social workers everywhere” she said. “Our hearts are kind and compassionate and caring in Missouri and in every other state, and I’m so proud to be a part of this chapter.”

Ban Anticipated

In December, when abortion law allowed the procedure in North Carolina until 20 weeks and six days, people from neighboring states with shorter time frames or total bans were “overwhelming” North Carolina abortion providers, NASW North Carolina Chapter Executive Director Valerie Arendt said.

It’s anticipated the state legislature will reintroduce a total ban, or a reduction in the allowed time frame, when it gavels in this year, she said. And since the senate has a super majority of Republicans, it can override a veto of the governor, a Democrat with two more years to serve what legally is a mandated final term.

In legislation from prior years, after a 2016 bathroom bill banned people who identify as trans from using public restroom facilities, “the state lost hundreds of millions of dollars” of income, Arendt said.

When the legislative session begins this year, Arendt said the chapter is expecting the introduction of new legislation targeting those who identify as LGBTQIA+, and especially trans individuals — and that may pass in the 2023 session.

She said last year a parents’ bill of rights passed both the senate and house, and would have outed teachers for talking about trans issues, had it been signed before the session ended.

“We anticipate something similar will be reintroduced in 2023,” Arendt said, and also expected is legislation to limit trans health care.

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“To answer the question of how to provide clients with the support they need, we need to provide clients with information on how to resist when laws come up against our ethics,” she said. 

“It’s in our social work ethics to help clients with self-determination. People should make their own decisions on their own values.”

Protecting Practice

“How is NASW-Ohio protecting ethical social work practice in our changing political landscape?” That question is answered in 10 action statements as part of the chapter’s online section informing, mobilizing and encouraging members to act to “Protect Ethical Social Work Practice.”

Two of those statements are: “NASW Ohio is actively mobilizing other health and human services associations around a collective advocacy goal—to stop the criminalization of ethical practice and protect our health and human services workforce, and establishing our new Task Force on Criminalization of Social Work Practice to support and guide NASW Ohio’s advocacy work around these issues.”

“This year we were able to stop a ban on gender-affirming care for minors or face the licensing board,” said chapter Executive Director Danielle Smith. “In the new year, a governor could sign it and punish people for providing gender-affirming care, which is the NASW code to do something.”

It’s uncertain if the majority has the votes to do that or if someone will break party ranks to stop it, she said, leaving uncertainty about what the new year holds on both gender-affirming care and abortion access.

There’s a coordinated attempt across the country, started by conservative organizations decades ago, to gain political power by politicizing or criminalizing issues or attacking or scaring providers as a way to sway or prevent them from providing some kinds of care, Smith said. “And there is an active effort to demonize and exploit trans folks in this country, and we need everybody to take action.”

She believes criminalizing providers will be next for many red states, including Ohio. One thing social workers can easily do is talk to other people in their communities and encourage everyone to call their legislators.

“What’s very frustrating is the general population in the United States and in Ohio support abortion access,” Smith said. “(Politicians) gerrymander districts and are not doing what people want. It’s bleak, but we’re not giving up. We will continue to provide care and help so people can access services.”

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