By Leora Lowenthal, LICSW, OSW-C, MPA, FAOSW

When asked to write a piece about ethics in psycho-oncology care, I immediately agreed with enthusiasm. For as long as I have been a social worker, I have used the NASW Code of Ethics as a map of sorts, believing it could guide me through most if not all quandaries. Perhaps more importantly, until 2020 I never doubted my ability to honor the code and standards within.
 
Facing the task at hand, my goal was to examine the often seemingly insurmountable challenges from the past two years and consider the moral distress that may result from a work life (and world) that doesn’t neatly adhere to the demands of the code. I started by compiling a list of challenges I encountered or witnessed since March 2020, which I then planned to cross-reference with the Code of Ethics. Mid way through the second page I began to question my original plan. Was it helpful to raise awareness of moral distress without having carefully considered action steps to suggest? Was the Code of Ethics even written with an understanding of the world as it exists today? I wasn’t sure so for the first time in many years, and decided to revisit the code’s history.
 
History in a nutshell:
 
The original NASW Code of Ethics was approved by Delegate Assembly on October 13, 1960; it was one page long and provided 14 principles intended to guide the profession. In the interest of being succinct I will simply say; it was an easier code to live up to.
 
In 1967, the code (still one page) was amended to include a 15th statement of principle addressing anti-discrimination: “I will not discriminate because of race, color, religion, age, sex or national ancestry and in my job capacity will work to prevent and eliminate such discrimination in rendering service, in work assignments, and in employment practices.”
 
It wasn’t until 1979 that the code began to resemble the document we know today. The newly approved version included a preamble, six sections of standards, a total of 82 principles and came out to a whopping nine printed pages. It began parsing out the different stakeholders and identifying principles meant to guide social workers in their ethical responsibility to clients, colleagues, employers and employing organizations, the social work profession and society overall. The complex and sometimes competing expectations for the role were taking clearer form.
 
While the 1980s were relatively quiet on the code front, the 1990s brought a flurry of activity. In 1990, revisions were made to the language of principles related to the solicitation of clients, fee setting and accepting compensation for referrals. In 1993, five new principles were added including those pertaining to social worker impairment and dual relationships. In 1996, the code got a full re-write resulting in a 33-page document that included a preamble, purpose, ethical standards, ethical principles and an index. Finally in 1999 a small revision was made, clarifying circumstances in which a social worker may need to disclose confidential information without a client’s consent. We had entered a new era.
 
In 2008, the language around anti-discrimination was revised in several sections. The new, expanded language provided attention to anti-discrimination on the basis of “race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical disability”. The code also became available in Spanish.
 
2017 brought another significant revision of the larger document. The majority of changes focused on the use of technology and implications for ethical practice. Other notable revisions included a change from use of the term “disability” to “ability” and renaming the section previously entitled “Cultural Competence and Social Diversity” to “Cultural Awareness and Social Diversity.”
 
The most recent revisions were made in 2021, a year characterized by the recognition of need for systemic change. The code revisions had two main components: addition of language around self-care in the “purpose and principles” section, and multiple changes to Standard 1.05, which had now been re-titled from “Cultural Awareness and Diversity” to “Cultural Competence.” The most striking aspect of the revision to this standard was the introduction of a mandate stating that social workers “must take action against oppression, racism, discrimination, and inequities, and acknowledge personal privilege.” I’d like to say that when this revision was made, I noticed and celebrated the shift in language but truthfully, I did not. The realization brought me to a full stop.
 
Perhaps needless to say, the original plan for this piece is long gone. I did not resolve my questions regarding moral distress nor establish a brilliant and inspiring list of action steps. Instead, I was uncomfortably aware that in the chaos of the preceding two years, I had paid little attention to the changes in our profession’s code of ethics. Maybe in the future I will be prepared to write about the relationship between moral distress and the NASW Code of Ethics. First, as mandated, I needed to privately acknowledge the personal privilege that had allowed me to go almost a year without recognizing the significance of the 2021 revisions. Second, I wanted to share that acknowledgment here in the hope that it may be useful for others. And while I do still wonder how we can live up to all that the code asks of us, I appreciate having the opportunity to explore with you, my extraordinary and wise colleagues, and look forward to seeing many of you in Raleigh this June. For those who wish to learn more, please see below for some places to find more detailed information, including copies of all the code versions.
 
NASW

• www.socialworkers.org/About/Ethics
• www.socialworkers.org/About/Ethics/Code-of-Ethics/History

 
The New Social Worker, “Ethics Alive” series written by Allan Barsky JD, MSW, PhD

• https://www.socialworker.com/feature-articles/ethics-articles/the-2017-nasw-code-of-ethics-whats-new/

• https://www.socialworker.com/feature-articles/ethics-articles/special-report-2021-revisions-nasw-code-of-ethics/