Questions of ethics lie at the heart of government responses to Covid-19, professional reactions and citizens’ behaviour. Such questions include: Do we value health or the economy? Who gets the protective equipment, ventilators or food vouchers? Is combatting loneliness worth the risk of spreading or contracting the virus?
During May 2020, a group of academics in partnership with the International Federation of Social Workers (IFSW) launched a qualitative survey, asking for details of the ethical challenges faced by social workers during Covid-19. We described ethical challenges as ‘situations that give cause for professional concern, or when it is difficult to decide what is the right action to take’. 607 responses were received from 54 countries, the full details of which can be found in the published report (Banks et al., 2020). The types of challenges reported were very varied, but we identified six main themes:
- Creating and maintaining trusting, honest and empathic relationships via phone or internet with due regard to privacy and confidentiality, or in person with protective equipment.
- Prioritising service user needs and demands, which are greater and different due to the pandemic, when resources are stretched/unavailable and full assessments often impossible.
- Balancing service user rights, needs and risks against personal risk to social workers and others, in order to provide services as well as possible.
- Deciding whether to follow national and organisational policies, procedures or guidance (existing or new) or to use professional discretion in circumstances where the policies seem inappropriate, confused or lacking.
- Acknowledging and handling emotions, fatigue and the need for self-care, when working in unsafe and stressful circumstances.
- Using the lessons learned from working during the pandemic to rethink social work in the future.
Not surprisingly, these themes signal a complexity that goes beyond simple dilemma formulations (such as service user autonomy versus the public good), and include aspects of the contexts in which they took place (e.g. on the internet or phone, in unsafe circumstances). While the types of ethical challenge listed above are familiar in social work (maintaining confidentiality, balancing the rights of different parties) the difference between pandemic times and ‘normal’ times is that for some of the social workers responding to the survey, the whole of their professional lives had become a dilemmatic nightmare. And even ‘dilemma’ may not encapsulate the complexities faced – as one Canadian social worker reported a ‘triple edged choice’ about whether to place a service user in respite hospital care. This worker was balancing the needs of the family for respite, versus the dangers of having a family member in hospital, versus the need for hospital beds to be available for Covid-19 patients.
A UK social worker arranging to move children to a new foster home, deciding to use her own car and staying with the children to settle them in, commented: ‘I am used to assessing risk in others but now I am a potential risk, and now I am at potential risk. This makes me feel very uneasy’. This social worker went on to describe a long and difficult process that took her from court, to collect the children and take them safely across a road, while unsafely holding hands and without a mask, to her car and then to their new home. She remarked that she felt ‘anxious throughout’. The normal everyday practices of social work, such as attending court or making home visits, have become difficult or impossible face-to-face, requiring complicated arrangements or inadequate digital communications. The ethical and practical logistics of such activities could be described, metaphorically, as mirroring at a micro level the supply chain logistics of the National Health Service.
In countries in Africa, Asia, South and Central America, surprisingly similar ethical challenges were reported (relating to maintaining the dignity, respect, privacy and autonomy of service users, and distributing scarce resources fairly) although in very different contexts. As a social worker from Puerto Rico commented: ‘Some colleagues do not even have wifi to connect, and use the hotspot of their cell phone … those [service users] who do not have the means and do not have technology, may need to attend our offices … ‘ While a young social worker in a rural area of Pakistan reported doing community work with older people, who were religious and illiterate, and did not believe in Covid-19. His job was to provide sanitising equipment and try to educate them about the pandemic.
Many responses focused on the very real day-to–day ethical challenges faced in the moment, often describing feelings of exhaustion and stress, along with negative emotions such as fear (of the virus), shame (at not providing a better service) or guilt (at being complicit in unsafe or unfair practices, such as discharge from hospitals to care homes without testing). A Chinese social worker commented about working at the height of the pandemic: ‘There were a lot of challenges and plenty of hard decisions to make, but we did not have time to think and reflect. I felt like I was at a war.’ Yet some did take the opportunity of filling in the survey to stop and reflect, particularly on the lessons for social work in the future and the need to rethink its organisation and practice. In many countries social work is not well understood or valued and social workers were not recognised as key workers during Covid-19. Yet much creative and innovative practice has taken place throughout the world during the pandemic, as social workers have found ways to move food banks to the street, support the setting up of volunteer helplines, community-based child protection initiatives, or additional domestic violence programmes (see Truell, 2020). An Italian social worker suggested experience during the pandemic had generated productive learning, describing the process of going from ‘work as usual’ to unusual ways of working.
A many commentators are now emphasising, it is essential that social work asserts its role in the fight for human rights and social justice, as the pre-existing inequities in all societies have been exposed by the pandemic, and it is important that the impending economic downturn does not lead to cost-cutting and minimising of already stretched social welfare systems. There are many actions that can be taken by social work employers, governments, and professional associations, as well as social workers, to enable the conditions for effective and ethical practice. The report of our findings from the research concludes with a set of recommendations, of which the following is a summary (Banks et al., 2020):
Social workers need to: rethink how to apply professional values and principles in new contexts; engage in ethical deliberation with colleagues; be aware of the impact of exhaustion and emotion on their capacity to see the full ethical implications of situations and to treat people with respect, empathy and compassion; and raise with employers, professional associations and policymakers the serious harms and inequities experienced by people during the pandemic, the difficulties in delivering social work services and proposals for improvements.
Social work employers should: ensure all social workers and students on placement are supported through regular supervision and team meetings; develop guidance with frontline workers about how to operate safely and ethically; monitor levels of stress amongst staff and ensure adequate rest and recuperation: provide necessary hygiene equipment and safety measure; advocate to governments and draw attention to gaps in welfare systems and the need for improvements.
National and international associations of social workers (including IFSW) have key roles in: highlighting systemic factors putting some populations at risk and the vital role of social safety nets; intensifying efforts to collect evidence on conditions for social workers and service users; advocating strongly with employers and governments to recognise social work roles and provide better guidance for maintaining services; and continuing to develop ethical guidance for social workers and employers and spaces for peer support and learning about ethical dilemmas in practice.
Governments need to: recognise the critical role played by social workers in providing and supporting social and community-based care during a pandemic; acknowledge social workers as key workers; ensure provision of the necessary hygiene and protective resources; issue clear guidelines on how to maintain social work services during a pandemic, keeping services open while operating as effectively and safely as possible.
Acknowledgements: Thanks to all the social workers, students and academics who took time away from their busy lives to share their insights and experiences; IFSW for support; and Durham University Economic and Social Research Council Impact Acceleration Account for a small grant for research assistance.
Sarah Banks, Durham University, UK, firstname.lastname@example.org
Tian Cai, Durham University, UK, email@example.com
Ed de Jonge, University of Applied Sciences, Utrecht, Netherlands, firstname.lastname@example.org
Jane Shears, British Association of Social Workers and IFSW Ethics
Michelle Shum, Hong Kong Baptist University, Hong Kong, email@example.com
Ana M. Sobočan, University of Ljubljana, Slovenia, AnaMarija.Sobocan@fsd.uni-lj.si
Kim Strom, University of North Carolina, USA, firstname.lastname@example.org
Rory Truell, IFSW Secretary-General, email@example.com
María Jesús Úriz, Public University of Navarra, Spain, firstname.lastname@example.org
Merlinda Weinberg, Dalhousie University, Canada, Merlinda.Weinberg@Dal.Ca
Banks, S., Cai, T., de Jonge, E., Shears, J., Shum, M., Sobočan, A.M., Strom, K., Truell, R., Úriz, M.J. and Weinberg, M. (2020) Ethical Challenges for Social Workers during Covid-19: A Global Perspective, Rheinfelden, Switzerland, International Federation of Social Workers, https://www.ifsw.org/wp-content/uploads/2020/07/2020-06-30-Ethical-Challenges-Covid19-FINAL.pdf
Truell R. (2020) Covid-19: The struggle, success and expansion of social work Rheinfelden, Switzerland: International Federation of Social Workers, www.ifsw.org/covid-19-the-struggle-success-and-expansion-of-social-work