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Chapter 4 The Social Worker as Moral Agent Jean-Marc Larouche and Tim Flaherty INTRODUCTION In the course of the literature search on nurses and physicians, the indicators drawn from professional journals and texts were collected into dimensions that gave us three ideal types of each profession with distinct approaches to ethical issues due to their distinct implicit ethics. In the course of the documentary analysis on the social worker, having used a corpus of literature comparable to that for physicians and nurses, it became evident that our discussion of the social worker would be different. First of all, it is clear that for the social worker in the field of pediatric chronic illness, there is more consensus on the nexus of the profession. Second, we noted no significant differences in the writing analyzed that would allow us to sketch more than one ideal type of social worker. We did identify four major characteristics of the social worker, and will distinguish these in the discussion of the history of the profession and in the discussion of autonomy. This will allow the reader to note the lack of distinctiveness of indicators and support the conclusion of the existence of one major ideal type. This chapter begins with a brief account of the emergence of the social worker in the field of health care. We note the major characteristics of the social worker and indicators of the one ideal type that we construct. HISTORICAL PERSPECTIVE The social work profession has traditionally been engaged in a commitment where concern for both the person and the person'senvironment is paramount.1 Social work in a health care setting is said to have begun 1. Card B. Germain, "Social Work Identity, Competence, and Autonomy: The Ecological Perspective," Social Work in Health Care 6, no.l (September 1980): 1-10. 77 IMPLICIT ETHICS OF PROFESSIONALS IN THE FIELD OF PEDIATRICCHRONIC CARE around 1905 to 1920, a period that saw the practice of social work first being established in psychiatric hospitals.2 From the start of social work in a Boston hospital at the turn of the century, the goals of medical social work were to help patients and families deal with illness and to help them in retaining their sense of control over their lives.3 The period from 1905 to 1920 saw social work firmly established in health care settings.4 Social work grew during the 1920s in response to the growth of public health progress and the need for preventive programs in the education system. By the 1930s, the influence of federal programs demanded that social work departments develop to better serve economically disadvantaged groups. Throughout the 1940s and 1950s, social workers received training in and practised a psychoanalytic approach to their work. Initiated in part by the struggle for civil liberties, social work of the 1960s emphasized social action and the need to eliminate those things that caused social and psychological dysfunction. During the 1970s and 1980s, the social work profession turned from this outward evaluation to an inward and self-oriented evaluation.Duringthis period, the profession gathered data, developed its theoretical approaches and technical skills, and progressed toward specialization. Through increased self-awareness, public sanction and funding, the profession was able to realize a status of independence. It sought its own autonomy, rather than being dependent on physicians for guidance.5 Originally, social work practice in health care was intended to be a support for the physician.6 In the late part of the nineteenth century in the United States, physicians were appointed to assist other physicians by visiting patients at home, interpreting instructions to the patient and reporting on home conditions. It was later evident that a nurse with an ability for social service was required, since not only were nurses familiar with medical practice, but at the time, it was being perceived that a patient 's difficulties in his or her personal life may be the cause, and not the result, of the illness. Social work, then, attempted to focus on alleviating broader social issues. The role of the social worker became one of the 2. Abraham Lurie, "Social Work in Health Care in the Next Ten Years," Social Work in Health Care 2, no. 4 (June 1977): 419-428. 3. Susan J. Bendor, "The Clinical Challenge of Hospital-Based Social Work Practice," Social Work in Health Care 13, no. 2 (Winter 1987): 25-34. 4. Lurie, "Social Work in Health Care in the Next Ten Years," 419-428. 5...

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