左右為難：早期療育社工員倫理議題與決策

Social Workers’Ethical Issues and Decision Making in Early Intervention Service Agencies

早期療育社工員在機構中必須與家長及專業人員、組織等系統合作，服務過程中彼此不同的價值觀及立場產生衝突，使社工員陷入倫理兩難的情境，而處理這些倫理議題的決策也將影響到服務對象的權益及社工員本身，然而國內並未有相關倫理研究。本研究先就早期療育服務中的倫理議題做為開端，再以不同領域社工角色下面臨的倫理決策，系探討早療社工在機構面臨的倫理情境，以及其採取的倫理決策。選取8位早療社工員，透過深度訪談法及主題分析法完成資料蒐集與分析。研究結果顯示：1.早期療育社工員面臨的倫理議題可分為與家庭工作、與系統工作兩部分。2.倫理決策會歷經倫理覺察、倫理判斷、倫理行動等階段。經由研究結果與討論，本研究建議：1.社工培養自我覺察與反思能力。2.社工實務強化倫理議題的訓練。3.社工教育融入華人文化脈絡的倫理思辨。

Rationale and Purpose: Early intervention services require interdisciplinary collaboration among various professionals (e.g., social welfare, medical health, and education) for providing necessary treatment, education, consultation, referral, placement, and other services based on the individual needs of children under 6 years old with developmental delays and their families. Social workers in early intervention agencies must cooperate with parents, professional practitioners, organizations, and even specific departments. Social workers frequently encounter conflicts resulting from differing values and viewpoints, leading to ethical issues. The ethical decisions made to address these issues also affect the rights of service users and the values of social workers. Previous findings indicate that factors contributing to ethical conflicts between parents and schools in special education include inconsistent views on children or their needs, insufficient parental knowledge, service content, reciprocity, physical restraint, the value of children with disabilities, communication, and trust. Early intervention social workers must weigh whether to refrain from reporting responsibilities to maintain relationships in family work. In the organizations where they are employed, social workers may hesitate to report their colleagues’unethical behavior on a case. Because of an organization’s scale, social workers in early intervention service agencies may discuss cases through supervision or rely on themselves to make decisions. However, no study has explored this ethical issue in the context of Taiwan. This study aims to analyze the ethical issues in early intervention service agencies. Using the empirical method, this study explores the ethical dilemmas that early intervention social workers may encounter in institutions and the ethical decisions that they experience. Ethical issues can be divided into ethical problems and ethical dilemmas. When an ethical problem does not involve conflicts or dilemmas of values, social workers can usually be solve it with minimal attention, intervention, or practical experience. Ethical dilemmas involve situations where more than two values or ethics conflict and a difficult choice must be made . The main questions of this study are as follows. (1) What issues do early intervention service social workers encounter in ethical institutions? (2) How do early intervention service social workers make ethical decisions? Methods: The research involved in-depth interviews with eight social workers from early intervention agencies, who were analyzed using the thematic analysis method. First, the authors numbered the sentences and performed initial coding after transcribing the verbatim manuscript. Second, they summarized and organized secondary and main axes to confirm the mutual exclusivity, spread, and rationality of identified themes. Finally, the authors interpreted the analyzed themes and assigned them story-telling labels. This study was conducted in compliance with the ethical standards for voluntary participation, and informed consent was obtained for the entire research process. Findings: The research results revealed the following. (1) Ethical issues can be divided into family work and system work. Social workers operated in a multi-professional and complex institutional environment, where relying solely on ethical codes or institutional rules without considering personal values is risky. Ethics education should incorporate value formation, ethical decision-making, and the cultivation of self-awareness. Social workers might experience conflicts with parents because of their children’s developmental difficulties, poor expressive abilities, and limited self-determination. Educational staff burdened with heavy workloads may punish children, leading to ethical dilemmas for social workers working within the system. Most social workers were employed by early intervention agencies, and this situation may potentially cause conflicts between individuals and organizations. Building cultural abilities with ethical judgments in Chinese society is crucial. Most early intervention agencies operated under interdisciplinary collaboration models, but a lack of mutual understanding and respect hindered effective collaboration, increasing ethical dilemmas in practice. (2) Ethical decision-making involves stages such as ethical awareness, ethical judgment, and ethical action. Social workers must develop self-awareness and consciously make ethical judgments while applying ethical codes. Adequate support enables social workers to confidently make suitable decisions for their clients. The study results revealed that different early intervention service social workers had different considerations when addressing similar situations, and even with similar considerations, their final ethical actions might differ. Considerations can be categorized at the rules, value, and benefit levels. After making careful ethical judgments, social workers undertook various ethical actions, including negotiation, borrowing, avoidance, and compromise. Principles guiding the decisionmaking of social workers during the process of providing services included the protection of life, equality of difference, autonomy, freedom, minimum harm, quality of life, privacy, confidentiality, and sincerity. Promoting the best interests and self-determination of clients was a priority for service providers. If the client is a minor or a person with a disability, the guardian's wishes should be respected unless the decision infringes upon the legitimate interests of the client. Implementations/Recommendations: (1) Cultivation of selfawareness and reflection skills: Most early intervention service social workers begin making ethical judgments and taking action by becoming aware of their own status. They are aware of their emotions, senses, actions, and values, reflecting on their experiences throughout the process. Social workers’relationships with their peers and the organizations employing them also affect ethical dilemmas. Thus, social workers should proactively consult with colleagues to enhance protective factors that help them to address ethical dilemmas. (2) Strengthening of professional training for addressing ethical dilemmas: High-quality ethical decision-making requires substantial institutional support and resources. Establishing a consultation group to assist social workers in ethical decision-making is recommended. In addition to teaching ethical theory, educators should divide students into groups on the basis of their specific areas of practical application. Social workers from various units should discuss practical ethical dilemma cases to stimulate their ability to undertake ethical judgments and actions. (3) Integration of ethical judgments into Chinese culture: When social workers lack the cultural ability to identify ethical issues, they may violate various ethical codes. Further studies on ethical cases emphasizing cultural sensitivity in the context of Chinese culture should be conducted. Expanding research on ethical decision-making would provide various practical insights. Early intervention service social workers must make difficult decisions when addressing ethical issues, specifically decisions based on the law, codes, relationships, the best interests of the case, professional values, and available resources. Finally, professional practitioners should build ethical guidelines for early intervention services. Incorporating ethics codes and courses into training programs will enhance the ability of social workers to effectively address ethical issues.