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Social work ethics
Book reviews this work was The Yellow Emperor’s Manual of Esoteric Medicine; its two principal divisions, Pure Questions and Answers, and Spiritual Pivot, reflected a preoccupation with pathological taxonomy. The geopathological views of the Chinese physicians of the time coincided astonishingly with Hippocrates’ attribution of the origins of disease to the “airs, waters and places”. In terms of endogenous pharmacology, the empirical clinical uses of ephedrine (for example) had already been known in China for three thousand years by the time of the Nei Ching’s compilation. Traditional Chinese medicine depended formally, then, on an orderly nosology. In therapy, herbology has been used since Chinese antiquity and continues to hold much professional appeal in the contemporary setting. This predilection for natural remedies, aside from re-opening for the reader the classical debate on homeopathy vs allopathy, found its flowering in the life and work of Li ShihChen (1518-l 593), often called China’s greatest naturalist. By the middle of the second millenium of our era, diagnosis in China depended extensively on sphygmological observations. Li did not reject these; he simply insisted that sphygmology be supported by wang (general physical condition of the patient, including his color and glossocopy), wen (auscultation, ophristics), another wen (anamnesis, to include the subject’s medical history), and chhieh (sphygmology combined with palpation). Li also updated the great medical works represented by the Nei Ching and major medieval publications of the years 1082, 1116and 1249 when he published (although posthumously) the Pen Tshao Kang Mu, a comprehensive medical encyclopedia (1596). The medicine derived from Aristotle and Galen did not penetrate into China until the first Jesuit technical advisors appeared in China’s capital. By the mid-nineteenth century, sufficient “Western” medicine was known in China to be used selectively, side by side with traditional diagnosis and therapy, by Chinese physicians. Since the success in 1949 of the revolutionary movement, new facets of Chinese medicine have captured the world’s imagination: acupuncture analgesia (1958); acupuncture to treat drug addiction (a technique actually transferred from Hong Kong hospitals to North America); more recently, the application of electro-acupuncture to raise pain thresholds (practised in Sweden); and electrosleep (used in the Soviet Union in order to treat a variety of ailments). The experience in China .proper . with neonatal preventive meditine has been the object of growing interest among nonChinese practitioners, especially in Cuba, the Socialist Republic of Viet-nam, France, and even elsewhere. Following the Cultural Revolution of the late 196Os, modern medical education in China begins at the age of 20 or so and continues for three years. Dentists, public health technicians, auxiliary medical personnel (including the famous barefoot doctors, workers trained to dispense preventive emergency treatment and to prescribe measures), all are trained separately from physicians. There are, furthermore, no written prescriptions in China and even medical texts can be bought easily in the shops. How is New Medicine working in China? Editor, Frederick Kao, reports that the socio-economic phenomenon of integrating Eastern and Western theory and practice, “coupled with a unique form of socio-political organization”, has made it possible now to serve adequately the needs of the entire population, “an accomplishment worthy of note”. The only element missing from this useful and highly readable, small volume is a chart depicting Chinese dynastic succession. since the namks of the Shang, Chou and Ming eras have little meaning for the average reader. Editor, Impact of Science
on Society, Paris, France
JACQUESRICHARDSON
145
Preventive Medicine in the United States lCJOtF1975, by GEORGEROSEN.Science History, New York, 1975. 94 pp.
$6.95 (paper) $3.95 The hopes and frustrations of efforts within medicine and society in America to prevent the onset and spread of disease are written about and pictorially illustrated in this splendid 94 page monograph-by George Rosen. The monograph describes the growing drift towards government &t&vention to amel;orate the ravages of poverty and disease, which joined with private voluntary efforts, at the start of the 20th century, to create a new movement to improve the health of the nation. Reformers in the movement sought to define standards for income, housing, food, and health care. They connected the national interest with health protection and proclaimed their faith that the prevention of illness was feasible. Rosen examines the policies and individuals in this movement, ai well as the scientific breakthroughs that made it possible-bacteriology, immunology, and antibiotic therapy to name a-few. He describes the campaigns in the United States against diseases such as tuberculosis, diphtheria, syphilis, cancer, and habits such as cigarette smoking. In doing so he delineates and contrasts the difficulties of preventing communicable acute illness with the difficulties in preventing non-communicable chronic disease. He thoughtfully questions, in the conclusion, the current state of preventive medicine in the context of national health policy and seeks to give direction in charting its future. This is one of the most concise and informative works on 20th century preventive medicine in the United States that exists in the literature. Harvard Medical School Countway Library Boston, Mass., U.S.A.
STANLEYJ. REISER
Social Work Ethics, by CHARLESS. LEVY. Human Services
Press, New York, 1976. 266 pp. $14.95 Charles Levy has published a number of articles on the subject of ethics and values in the context of social work practice. This book incorporates some of his earlier articles and elaborates the whole spectrum of ethical issues that pervade the worker-client relationship. The first part of the book sets forth a rationale for social work ethics and the framework for its operation. The two most interesting chapters, “Social Worker as Fiduciary” and “The Power Base of Social Work”, describe the service situation out of which the ethical position emerges. The author begins with the client’s need for help, his trust in the worker’s expertise and the ensuing feelings of dependency. The uneveness of such a relationship leads to a diminished sense of autonomy for the client and a power position for the worker. “The social worker’s power is a function of the client’s vulnerability and the client’s vulnerability is a function of the social worker’s power” (p. 70). The ethical imperatives derive from this relationship because the social worker has become a force in the life of the client and therefore must fulfill the commitment as a fiduciary. A power relationship Presents opportunities for abuse and hence the need for group ethics as a restraining influence.
146
Book reviews
It is regrettable that the author does not follow up this penetrating analysis and make more explicit the ethical dilemmas that inevitably ensue from this inequality of influence and the controlling base of social work practice. He merely cautions against abuse and even raises “the nagging possibility that some individuals might gravitate toward the practice of social work because of the power it promises” (p. 77). Levy states that technical competence in the practice of social work must be assumed before ethical issues can be raised. His emphasis is on values “right in themselves” rather than on the efficiency of performance. When conflicting issues require ethical judgments, he perceives a clear order of priorities based on the fact that rightness in ethical terms is the higher value. He illustrates this aspect by posing a situation in which a social worker grapples with the issue of confidentiality in her work with a group that engages in unethical behavior. The ultimate choice of action must be made on the side of ethical principles. The second part of the book outlines standards of expected conduct in relationships with the client, the employing agency, third parties, colleagues and unions. Levy exhausts the full spectrum of activities and articulates the basic values that govern all these relationships. He deals with the issues of accountability, confidentiality, objectivity and acceptance and with the importance of involving the client in decision making. He is highly prescriptive about what a worker should value and the whole book is heavily interspersed with “ought to’s” and “should’s”. He states that social work ethics “must be formulated in a manner that is empirically realistic” but some of his prescriptions sound more like articles of faith that have no resemblance to the actual reality in the field. For example, he describes the social worker’s service “as priceless and precious and one that cannot be exchanged for cash. Payment for it by fee or salary cannot be viewed as a reciprocal gesture but rather as a kind of practical arrangement not contingent upon the client’s means or financial capacity” (p. 57). This presumption of total altruism and beneficence is difficult to read, much less believe at a time when the politics of the service professions and their self-serving interests are increasingly being clarified. The notion of care as the sole basis for giving services, no longer has credibility. Similarly, he stresses the need to maintain objectivity while allowing that “it may be impossible to prevent unconscious intrusion of values”. The delusion of objectivity has long been abandoned and in the opinion of the reviewer this must be clearly affirmed before any discussion of the ethics of social work intervention can progress. Levy cautions against any negative feelings toward clients that might prevent full and unbiased attention. This espousal of the “non-judgmental attitude” is frequently encountered in social work literature, but does not rep resent the reality of practice. It ignores the normative base of the profession. Furthermore, it is unrealistic to expect a worker not to react to behavior that is alien or repugnant to her own system of values. To prevent these negative feelings from interfering with the treatment efforts, they must be recognized and acknowledged. Awareness of their existence, rather than denial of them, will do more to insure dfective service to such clients. The author devotes a chapter to the societal goals of the profession in which he refers to “the dictate of ethical responsibility beyond the boundaries of the social worker’s relationship to. is client”. However, the elaboration of this “dictate” is glo 1 al and superficial. He does not deal with the conflicting demands of societal and individual goals and their integration through values. This issue has been a source of tension along the entire route of the profession’s history and is central to any consideration of social work ethics. The basic weakness of the book jr the failure to look
at facts and realities in the field and integrate them with values. In the final analysis, it. is the unfolding of reality that provides the source and authority for an ethical system. The limitations notwithstanding, the book remains an important addition to social work literature as a compendium on ethics that has not been attempted before. It is recommended as an overview of the espoused ethics of our profession, the base against which practitioners as well as students can grapple and come to terms with their own particular values and beliefs. Simmons College School OJ Social Work Boston, MA, U.S.A.
ANNE S. GERBER
Social Research in Conlliit with Law and Ethics, edited by PAUL NEJELSKI.Cambridge, MA., Ballinger. 1976. 197 pp. s15.00
Within the fields of social science and medicine, the last ten years could arguably be called the Decade of the Research Subject. in this period, in the United States at least, expressions of concern for the rights and welfare of subjects of medical or social research have become as common in professional parlance-if not always in professional conduct-as references to the current literature or levels of statistical significance. Assurances of informed consent are cropping up in the methodology sections of published research; hospitals and universities are rushing to establish procedures for certifying the ethics of research proposals according to guidelines of National Commissions and Federal granting agencies. Seminars, symposia, workshops, documentaries and books are tumbling into view, vying for the chance to extol human rights to privacy, confidentiality, informed consent, and the loyalty of physicians that is uncontaminated by non-therapeutic, investigative motives. Such has been the shape of society’s appropriation of the truths and horrors of Nuremberg. To a great extent, it has been the investigators themselves who have eloquently and persistently advanced this trend. Henry Beecher, Louis Lasagna and Margaret Mead come immediately to mind. At the same time, there is the nagging suspicion that many social and medical scientists are becoming increasingly tense and embattled. They perceive the advocacy of subject and patient rights as, at best, irresponsible meddling by a well-intentioned but unsophisticated public; or, at worst, as a threat to the vital center of the scientific enterprise. Certainly (these scientists declare) subjects’ rights are important, but what about researcher’s rights? This question is the major focus of Social Research in Conjlict with Law and Ethics. This book appears to represent a renewed militancy on the part of researchers who see themselves as hampered not so much by cumbersome ethics procedures and bureaucracies (although that view is expressed), as by two other developments: governmental agencies’ dedication to secrecy and self-protection, and the use of the subpoena power to require journalists and scholars to reveal confidential sources. The two issues of access to government information and testimonial privilege for researchers provide the primary framework for the ten articles collected in this volume. With considerable repetition, these articles make the following basic points: (1) Governmental agencies’ use of secrecy and the invocation of executive privilege tend to be self-serving and to obstruct the free flow of information on which an enlightened citizenry and an effective democracy depend. (Articles by Gideon Sjoberg Carol Barker, G. 0. W. Mueller, and Jack G. Day.)
on Society, Paris, France
JACQUESRICHARDSON
145
Preventive Medicine in the United States lCJOtF1975, by GEORGEROSEN.Science History, New York, 1975. 94 pp.
$6.95 (paper) $3.95 The hopes and frustrations of efforts within medicine and society in America to prevent the onset and spread of disease are written about and pictorially illustrated in this splendid 94 page monograph-by George Rosen. The monograph describes the growing drift towards government &t&vention to amel;orate the ravages of poverty and disease, which joined with private voluntary efforts, at the start of the 20th century, to create a new movement to improve the health of the nation. Reformers in the movement sought to define standards for income, housing, food, and health care. They connected the national interest with health protection and proclaimed their faith that the prevention of illness was feasible. Rosen examines the policies and individuals in this movement, ai well as the scientific breakthroughs that made it possible-bacteriology, immunology, and antibiotic therapy to name a-few. He describes the campaigns in the United States against diseases such as tuberculosis, diphtheria, syphilis, cancer, and habits such as cigarette smoking. In doing so he delineates and contrasts the difficulties of preventing communicable acute illness with the difficulties in preventing non-communicable chronic disease. He thoughtfully questions, in the conclusion, the current state of preventive medicine in the context of national health policy and seeks to give direction in charting its future. This is one of the most concise and informative works on 20th century preventive medicine in the United States that exists in the literature. Harvard Medical School Countway Library Boston, Mass., U.S.A.
STANLEYJ. REISER
Social Work Ethics, by CHARLESS. LEVY. Human Services
Press, New York, 1976. 266 pp. $14.95 Charles Levy has published a number of articles on the subject of ethics and values in the context of social work practice. This book incorporates some of his earlier articles and elaborates the whole spectrum of ethical issues that pervade the worker-client relationship. The first part of the book sets forth a rationale for social work ethics and the framework for its operation. The two most interesting chapters, “Social Worker as Fiduciary” and “The Power Base of Social Work”, describe the service situation out of which the ethical position emerges. The author begins with the client’s need for help, his trust in the worker’s expertise and the ensuing feelings of dependency. The uneveness of such a relationship leads to a diminished sense of autonomy for the client and a power position for the worker. “The social worker’s power is a function of the client’s vulnerability and the client’s vulnerability is a function of the social worker’s power” (p. 70). The ethical imperatives derive from this relationship because the social worker has become a force in the life of the client and therefore must fulfill the commitment as a fiduciary. A power relationship Presents opportunities for abuse and hence the need for group ethics as a restraining influence.
146
Book reviews
It is regrettable that the author does not follow up this penetrating analysis and make more explicit the ethical dilemmas that inevitably ensue from this inequality of influence and the controlling base of social work practice. He merely cautions against abuse and even raises “the nagging possibility that some individuals might gravitate toward the practice of social work because of the power it promises” (p. 77). Levy states that technical competence in the practice of social work must be assumed before ethical issues can be raised. His emphasis is on values “right in themselves” rather than on the efficiency of performance. When conflicting issues require ethical judgments, he perceives a clear order of priorities based on the fact that rightness in ethical terms is the higher value. He illustrates this aspect by posing a situation in which a social worker grapples with the issue of confidentiality in her work with a group that engages in unethical behavior. The ultimate choice of action must be made on the side of ethical principles. The second part of the book outlines standards of expected conduct in relationships with the client, the employing agency, third parties, colleagues and unions. Levy exhausts the full spectrum of activities and articulates the basic values that govern all these relationships. He deals with the issues of accountability, confidentiality, objectivity and acceptance and with the importance of involving the client in decision making. He is highly prescriptive about what a worker should value and the whole book is heavily interspersed with “ought to’s” and “should’s”. He states that social work ethics “must be formulated in a manner that is empirically realistic” but some of his prescriptions sound more like articles of faith that have no resemblance to the actual reality in the field. For example, he describes the social worker’s service “as priceless and precious and one that cannot be exchanged for cash. Payment for it by fee or salary cannot be viewed as a reciprocal gesture but rather as a kind of practical arrangement not contingent upon the client’s means or financial capacity” (p. 57). This presumption of total altruism and beneficence is difficult to read, much less believe at a time when the politics of the service professions and their self-serving interests are increasingly being clarified. The notion of care as the sole basis for giving services, no longer has credibility. Similarly, he stresses the need to maintain objectivity while allowing that “it may be impossible to prevent unconscious intrusion of values”. The delusion of objectivity has long been abandoned and in the opinion of the reviewer this must be clearly affirmed before any discussion of the ethics of social work intervention can progress. Levy cautions against any negative feelings toward clients that might prevent full and unbiased attention. This espousal of the “non-judgmental attitude” is frequently encountered in social work literature, but does not rep resent the reality of practice. It ignores the normative base of the profession. Furthermore, it is unrealistic to expect a worker not to react to behavior that is alien or repugnant to her own system of values. To prevent these negative feelings from interfering with the treatment efforts, they must be recognized and acknowledged. Awareness of their existence, rather than denial of them, will do more to insure dfective service to such clients. The author devotes a chapter to the societal goals of the profession in which he refers to “the dictate of ethical responsibility beyond the boundaries of the social worker’s relationship to. is client”. However, the elaboration of this “dictate” is glo 1 al and superficial. He does not deal with the conflicting demands of societal and individual goals and their integration through values. This issue has been a source of tension along the entire route of the profession’s history and is central to any consideration of social work ethics. The basic weakness of the book jr the failure to look
at facts and realities in the field and integrate them with values. In the final analysis, it. is the unfolding of reality that provides the source and authority for an ethical system. The limitations notwithstanding, the book remains an important addition to social work literature as a compendium on ethics that has not been attempted before. It is recommended as an overview of the espoused ethics of our profession, the base against which practitioners as well as students can grapple and come to terms with their own particular values and beliefs. Simmons College School OJ Social Work Boston, MA, U.S.A.
ANNE S. GERBER
Social Research in Conlliit with Law and Ethics, edited by PAUL NEJELSKI.Cambridge, MA., Ballinger. 1976. 197 pp. s15.00
Within the fields of social science and medicine, the last ten years could arguably be called the Decade of the Research Subject. in this period, in the United States at least, expressions of concern for the rights and welfare of subjects of medical or social research have become as common in professional parlance-if not always in professional conduct-as references to the current literature or levels of statistical significance. Assurances of informed consent are cropping up in the methodology sections of published research; hospitals and universities are rushing to establish procedures for certifying the ethics of research proposals according to guidelines of National Commissions and Federal granting agencies. Seminars, symposia, workshops, documentaries and books are tumbling into view, vying for the chance to extol human rights to privacy, confidentiality, informed consent, and the loyalty of physicians that is uncontaminated by non-therapeutic, investigative motives. Such has been the shape of society’s appropriation of the truths and horrors of Nuremberg. To a great extent, it has been the investigators themselves who have eloquently and persistently advanced this trend. Henry Beecher, Louis Lasagna and Margaret Mead come immediately to mind. At the same time, there is the nagging suspicion that many social and medical scientists are becoming increasingly tense and embattled. They perceive the advocacy of subject and patient rights as, at best, irresponsible meddling by a well-intentioned but unsophisticated public; or, at worst, as a threat to the vital center of the scientific enterprise. Certainly (these scientists declare) subjects’ rights are important, but what about researcher’s rights? This question is the major focus of Social Research in Conjlict with Law and Ethics. This book appears to represent a renewed militancy on the part of researchers who see themselves as hampered not so much by cumbersome ethics procedures and bureaucracies (although that view is expressed), as by two other developments: governmental agencies’ dedication to secrecy and self-protection, and the use of the subpoena power to require journalists and scholars to reveal confidential sources. The two issues of access to government information and testimonial privilege for researchers provide the primary framework for the ten articles collected in this volume. With considerable repetition, these articles make the following basic points: (1) Governmental agencies’ use of secrecy and the invocation of executive privilege tend to be self-serving and to obstruct the free flow of information on which an enlightened citizenry and an effective democracy depend. (Articles by Gideon Sjoberg Carol Barker, G. 0. W. Mueller, and Jack G. Day.)