Ethical Issues
Ethics is a term that can imply lofty, philosophical discussions, far removed from the
everyday world. In reality, workers in the substance abuse treatment field are constantly
faced with ethical dilemmas on an individual as well as a societal level. Ethics is an
intellectual approach to moral issues, a philosophical framework from which to critically
evaluate the choices and actions people take to deal with various aspects of daily living
( National Association of Social Workers [NASW], 1997
).
Working in the substance abuse treatment field presents dilemmas relating to personal beliefs,
j
udgments, and values. The history of how society views persons with addictions is fraught
with emotion, misperceptions, and biases that have affected the care of drug abusers. For
example, it is not unusual in a health care setting for a patient to be perceived negatively just
by being labeled a drug abuser (Carroll, 1995
). Because of the highly charged emotional
nature of the substance abuse treatment field, providers should possess the tools to explore
ethical dilemmas objectively. By doing so, and by examining their own reactions to the
situation, providers can proceed with the most ethical course of action. (See Appendix E for
the Federal and State codes of ethics for programs treating
HIV-infected substance-abusing
clients.
) Chapter 9
discusses the legal constraints, obligations, and options that provide the
framework within which ethical issues must be decided.
Ethical Issues for Treatment Providers
The Ethics of HIV/AIDS
other services.
Taking the most ethical course of action becomes even more complex when HIV/AIDS is
thrown into the mix of concerns that the client may present. HIV/AIDS has its own unique
ethical issues. Because HIV can be transmitted through sexual activity and by sharing drug
equipment, it evokes significant
p
ersonal feelings and judgments in the general public, as well
as in health and social service providers. Advocates for persons with HIV have fought for
years to maintain confidentiality, avoid mandatory reporting, and ensure access to care for
those with the disease. Because of the labels "drug abuser" or "homosexual" and the fear of a
backlash toward people with HIV, advocates have been pushing strongly toward preventing
discrimination. This has led to creating safeguards to protect these individuals from
discrimination in health care, employment, housing, and
E
thics on Micro and Macro Levels
Ethical issues are both personal (micro) and societal (macro) in nature. There is an ongoing
struggle between legislating morality for the "public good" and fighting to retain an
individual's right to autonomy. It is the intense emotional nature of such concerns that takes
an issue from a personal level to a societal level.
Syringe exchange programs (SEPs) are a good example of such ethical dilemmas. While