Alberta Disability Workers Association
Building a Valued, Proud & Professional Workforce

Ethical Decision-Making

When faced with a dilemma, it’s important to have a process to help us reach an ethical solution that in the best interests of those affected. ADWA’s Code of Professional Ethics & Conduct includes a brief description of an ethical decision making process within the third principle of Integrity and Decision-Making.

“As a disability professional, I will

  • Make decisions by identifying those affected, identifying the issues and circumstances involved, recognizing any personal biases and interest, weighing risks/benefits to the individual I support and others, and making appropriate decisions with the best interests of the people I support in mind.
  • Consult with my supervisor and other professionals when I am unsure about a decision, obligation or best practice.”

Here is an ethical dilemma that demonstrates how this works.

You provide support to Jack, a recently retired man. He doesn’t miss working, but he misses talking about sports with his co-workers in the coffee room each day. A co-worker tells you about a group of individuals who meet at the local coffee shop on Monday mornings with their workers that are in the same age range as Jack and several are sports fanatics. You check with one of the workers to make sure Jack would be welcomed and then make sure Jack is interested in trying out the group. At the coffee shop next Monday, Jack joins the guys and you join the other staff at a nearby table. While the staff are actively engaged in conversation, you notice that the individuals at the table with Jack say little once introductions have been made. Jack’s attempts to engage them in sports or other topics of conversation get little response. The other staff seem not to notice that the people they support are disengaged and look bored.

In this situation, an ethical disability worker sees the need to take action, but what is the best course of action to take for everyone involved? Think about what you would consider for each step of the process before clicking on the step to see our answer.

While your primary responsibility is Jack, your actions are also likely to affect Jack’s companions at the coffee shop, their support workers and their employer or employers. The public image of disability workers is affected by what is happening as the shop owners and patrons see staff apparently neglecting those they support while they enjoy themselves. You know that what is important to Jack in this situation is building a new circle of friends to socialize with who are interested in the same things he is. It is not clear what his companions hope to get out of the coffee meeting, but certainly the intent in their service plans would relate to being active in the community and/or building relationships with others. Their support workers clearly value the break from hands-on service and the social support of fellow disability workers.
It is unclear whether the other staff don’t notice that the individuals need help to engage, don’t have the skills to intervene successfully, or don’t care. However, unless coffee shop time is an unpaid break, they are not providing good value to their employer. The ethical principle of integrity suggest that you should report any unethical practices I observe to my supervisors, but also that you advocate for the rights of people with disabilities to have the services they need to have rewarding opportunities. You also recognize that as a professional, you are upset when you see behaviour of other disability workers that seems unprofessional and may be attributing lack of caring to the workers when it may be a different issue.
There are a variety of actions you could take in this situation. You could ask Jack if he wants to continue meeting with the group or try to find another coffee group to discuss sports with. It is possible that Jack is happy to have someone to meet for coffee and thinks that things may be better once he gets to know the people more. Or he may choose to move on. This solution has the advantage that it meaningfully involves the individual you support and respects his wishes. However, it does not address the needs of Jack’s companions for good social connection if you stop going there or if you do not intervene directly or by giving Jack some engagement strategies to try with them if he chooses to stay. You could simply report the apparently negligent staff to their employer, describing what you observed. While this solution is consistent with the Integrity and Decision-Making actions in ADWA’s Code of Professional Ethics & Conduct, it may make it difficult to work together with those or other co-workers if they share your action with others. You may find that others are unwilling to tell you about community opportunities that Jack might enjoy. As well, if the other staff simply needed guidance to see the issues or work effectively with individuals on conversational skills, you have lost the opportunity to build a more professional and skilled workforce. You could start by determining why the other staff in the situation are ignoring the unsociable behaviour of the individuals they support. You will need to find a respectful way to raise the issue without seeming to accuse them of neglect or incompetence. You might say what you are noticing at the other table and ask if this is typical for the group. Depending on the answer, you may be able to engage the staff in developing strategies to build social interaction among the individuals. If successful, this approach will give Jack a bigger social network, create a more positive experience for the other individuals, build a more skillful disability workforce and improve the public image of disability workers in that setting.
In this situation, the third option appears to be the best place to start. If the conversation with the other staff is handled well, some good may be done for everyone affected. If by their reaction the other staff are not as committed to providing quality services as they should be, the other courses of action may be reconsidered. In addition to addressing the immediate situation, it is also appropriate to consider the big picture. If the coffee shop scenario indicates a bigger problem in service delivery, perhaps training opportunities should be sought or developed to address skill gaps in helping with social skills.

Confidentiality and the "Need to Know"

Although disability service employers typically have new employees, contractors and volunteers sign an oath of confidentiality, people vary in how they interpret it. Some believe that they can share information about people freely within the support team or even within the organization (i.e., with others who have signed the same oath of confidentiality). This interpretation is simplistic and would anger a lot of individuals receiving support who correctly feel those people don’t have a right to know their private affairs. On the other hand, confidentiality rules do not require disability workers to keep everything they hear or see a secret from everyone.

The need-to-know principle

Confidentiality is governed by the need-to-know principle as noted in the third point in the list above. Other staff or volunteers who work with an individual do not always need to know everything about that person. However, sometimes they do need to know certain things. Likewise, sometimes people ask for information about an individual and you need to decide whether they need to know.

Your decision about whether to share a piece of information about an individual should be based on the need of the person to know that fact in order to make decisions that improve or maintain the well-being of the individual and others. For instance, your supervisor needs to know about significant events that will affect the types of services provided to the individual and how they are delivered.

Many other situations require a judgment call. If a potential employer asks a supported employment specialist why an individual needs a particular accommodation or why the person lost the previous job, the decision about how to respond should be based on whether the information will help the employer improve the individual’s chance of success on the job. If an individual’s home support worker from another organization calls to ask if the individual was involved in a fight recently, the fact that the person signed a different oath of confidentiality is less important than why they need to know. In both situations, it is appropriate—although not always necessary—to ask why they need to know before deciding how much (if anything) to share. Suppose the individual arrived home with a large bruise and is upset but can’t explain why. Your answer, if a fight did occur, should limit itself to only those details required for the home staff to be able to give suitable physical and emotional support, just as a communication book in the home should then include only enough detail to ensure good support by workers on the next shift.

Likewise, if you are asking someone for information about an individual, you should try to make clear why you need to know. This approach demonstrates your respect for the people involved and lets the other person make an informed choice about your need to know.

Control of privacy

Ideally, sharing of personal information should be controlled by the individual being supported rather than the disability worker. ADWA’s ethics code requires that members support individuals to share personal information that others need to know in order to make good decisions. This could include preparing individuals to talk about their disability as it affects their ability to do a job with or without accommodations or why they left their previous job. Sometimes, as in the example of the individual arriving home bruised and upset, the individual may not be able to articulate what others need to know in order to be helpful.

Individuals sometimes choose to share sensitive information about themselves in public as a way of speaking up about injustice or other social problems. The information they share may make others feel uncomfortable and they may try to shut the individual down by claiming that the information being shared is “private” or “confidential.” This response reflects a lack of understanding of what confidentiality is about. It is not about keeping information secret so much as it is about the right of the individual to control what happens to their own private information. Sometimes decision-makers need to know information they would rather not know in order to make the best choices for everyone.

Limitations on confidentiality

Individuals may assume that you will not repeat anything they share with you, i.e., everything is confidential. You may be required by law to share what you learn (e.g., abuse). If an individual says they broke the law, you become an “accessory after the fact” if you maintain the secret. Individuals should be told the limits of confidentiality before they share information so they can make an informed choice about whether or not to share it. Unfortunately, private disclosures sometimes come without warning. The respectful response is to explain in understandable terms why you need to share the information with others (e.g., to get good advice for him or her, to keep people safe, to help others make good decisions.) You may not need to divulge the identity of the individual or intimate details. Likewise, your chosen advisor should respect your efforts by not trying to guess or pressure you to disclose this information.

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Professional Boundaries