Informed Consent in Social Work

need to be acquainted to pro tect client rights and to avoid being held liable for malprac tice or negligence. THE EMERGENCE OF widespread conFrederic G. Reamer v. Society of New York Hospital in which cern recently about client rights has Justice Ca dozo set forth his oft-cited opin had a marked effect on contemporary social ion concerning an individual's right to self work practice. Discussions concerning determination: "Every human being of client rights to confidentiality, s lfWith i creasing frequency, adult years and sound mind has a right to determination, and privileged communic soc al workers are being exdetermine what shall be done with his own tion, for example, are commonplace in part nected to comvlu With leaal rebody."7 To do otherwise, Cardozo argued, because of the increased sensitivity of social . , , ¥. . . c , is to commit an assault upon the person, workers to the general subject of profesqwrementS to ODtatn injormea Revelations following World War II of medi sional ethics, and in part because of the co sent from clients. In thisarcal experiments performed without consent concern of practitioners about their own icle, the ev lution of the conof the subjects and following the civil rights liability. The noteworthy growth o social cept of informed consent is movements of the 1960s helped form the work literature since the mid-1970s on the trnrpn and itt imnlirntinns fnr foundation for current informed consent subjects of professional ethics and client . , , ^ legislation and guidelines.8 The red-letter rights is evidence of this phenomenon.1 social WOrK practice are CtlSevent during this era was the 1957 case of A central theme in discussions of client CUSSed. Particular attention is Salgo v. Leland Stanford Jr. University rights is the obligation of practi ioners conpaid to leg l statutes and case Board of Trustees, in which the phrase in tinually to inform clients about plans to inlaw with which social workers formed consent was introduced. The plain tervene in their lives, and to obtain client need to be acauainted to proliff in this case, who became a paraplegic consent to intervention. Consistent with the . . ,. _ , j , , following a diagnostic procedure for a cir longstanding commitment of the social ? * , culatoiy disturbance, alleged that his physi work profession to the value of selfbeing held liable for malpraccian failed to disclose properly ahead of determination, social workers traditionally ti.ce or negligence. time pertinent information regarding risks have respected the right of clients to parassociated with the treatment.9 ticipate fully in efforts to assist the clients.2 Although the concept of informed con Despite social worker commitment to and ^^sent has its origin in medicine and health discussion of the general concept of selfcare, recently it has been applied legisla determination, social workers through the principally those in the health care field, tively, judicially, and administratively to literature have provided little examination have debated these and other issues for a wide range of other client groups. Social of the manner in which client consent is obdecades. The historical roots of informed workers regularly provide services to these tained in practice, of circumstances when consent have been traced to Plato, who in client groups and social workers often must consent is required, and of permissible exThe Laws compared the Greek slaveserve as advocates for the mentally ill and ceptions to client consent.3 In this article, physician who gave orders "in the brusque retarded, minors, medical patients, prison the historical and legal background of the fashion of a dictator" with the free physiers, and research subjects, in agencies that concept of informed consent is described, cian who "takes the patient and his family provide mental health services, for exam informed consent standards are outlined, into confidence ... [and] does not give pie, social workers must be familiar with and exceptions to informed consent are prescriptions until he has won the patient's consent requirements related to voluntary detailed. The protection of client rights support."4 The medieval French surgeon, and involuntary commitment and the through informed consent and avoidance of Henri de Mondeville, also stressed the imrights of institutionalized and outpatient liability for malpractice and negligence are portance of obtaining patient consent and clients regarding the use of psychotropic discussed, as are the implications of inconfidence, although he also urged his coldrugs, restraints, aversive treatment formed consent for social work practice. leagues to "compel the obedience of his pameasures, isolation, sterilization, and tients" by selectively slanting information psychosurgery. What do local statutes re provided to them.5 quire for an individual to be committed to By the late eighteenth century, European a psychiatric facility against his or her and American physicians and scientists, wishes? To what extent does a facility's How much information should clients such as Condorcet, Mirabeau, Cabanis, client bill of rights require that clients be have about their circumstances, prognoses, Volney, Chaussier, Virey, Rush, Gregory, consulted about treatment decisions?10 and prospective treatment? Do social workand Young, had begun to develop a tradiSocial workers in agencies that serve ers have the right to withhold information tion that encouraged professionals to share minors must keep pace with rapidly chang from certain clients? If so, under what cirinformation and decision making with their ing standards regarding consent of minors, cumstances? Who should be authorized to clients.6 The first major legal ruling in the For example, consent issues arise related to consent for clients who are unable to make United States on informed consent is found abortion counseling, contraception, treat their own informed decisions? Professionals, in the 1914 landmark case of Schloendorff ment of sexually transmitted diseases,