Ethical dilemma

The Ethical Conflict: This situation presents a classic ethical dilemma that pits two core professional duties against each other:

Confidentiality: As a social worker, I have a fundamental duty to maintain the confidentiality of my client. Trust is the foundation of our therapeutic relationship, and breaking it could destroy the progress we've made and potentially harm Alex by making them less likely to seek help in the future.

Duty to Warn / Protect: I also have a professional and legal obligation to protect others from harm. Alex's statement about "making them feel the same pain" and their research into firearms, while not a direct, immediate threat, raises a serious concern about the potential for violence. I have a duty to assess the risk and, if necessary, take action to prevent harm to others.

The dilemma is whether to uphold confidentiality and risk potential harm to the sibling, or to break confidentiality to ensure the sibling's safety, potentially damaging the therapeutic relationship and Alex's trust.

Resolution Process

I did not make an immediate decision. Instead, I followed a structured, ethical decision-making model to navigate the complexity of the situation.

Identify the Core Values and Principles: I first identified the principles at play:

Beneficence: Acting in the best interest of the client (Alex).

Non-maleficence: Doing no harm to the client or others.

Autonomy: Respecting the client's self-determination (within safe limits).

Justice: Ensuring fairness and equal treatment.

Fidelity: Maintaining trust and loyalty to the client.

Consult with a Supervisor: I immediately sought supervision from my clinical supervisor, presenting the situation in a de-identified manner to protect Alex's privacy. My supervisor helped me to critically analyze the level of threat. We determined that while the threat was not imminent or specific enough to warrant an immediate call to the police (which would be required by law for an active threat), the potential for harm was significant enough to require action beyond just counseling.

Collaborative Safety Planning: I returned to my next session with Alex and approached the topic with empathy and care. I did not betray their trust by revealing the information to their family or authorities without their knowledge. Instead, I said something like, "Alex, I hear how much pain you're in. The things you've shared with me about the abuse and your feelings of wanting to feel safe are very serious. My first priority is to ensure everyone's safety, including yours. Can we talk about a plan to help you feel safe without bringing harm to anyone?"

Action Plan and Intervention: Together, we developed a safety plan. This included:

Involving a Partner Agency: With Alex's permission, I made a referral to a domestic violence support service for their sibling. This provided an avenue for the sibling to get help and for the situation to be de-escalated from an outside source.

Setting Clear Boundaries: I clearly explained the limits of confidentiality to Alex. I said, "While our sessions are confidential, I am legally and ethically obligated to report any direct, imminent threats of harm to yourself or others." This was done in a non-judgmental way to reinforce my role as a supportive but responsible professional.

Sample Answer

The Ethical Dilemma: Confidentiality vs. Duty to Warn

Setting: A social worker in a community mental health clinic.

The Situation: I am a social worker providing counseling to a long-term client, a young adult named Alex, who struggles with severe depression and anxiety. Over several months, Alex has made significant progress and our therapeutic relationship is strong. During a recent session, Alex becomes agitated and shares a troubling piece of information. They reveal that their older sibling, who lives with them, has been verbally and emotionally abusive, and that the abuse has been escalating. Alex says, "I'm so tired of feeling powerless. Sometimes I just wish I could make them feel the same pain they cause me." They then mention that they have been researching how to get access to a firearm, not to harm their sibling, but to "feel safe" and "have some control."