15.5 Ethics in the Field

Ethics are central to the work of health and human services professionals, who often face difficult decisions that impact the well-being of individuals and communities. These challenges range from maintaining confidentiality while fulfilling legal responsibilities to addressing inequities in healthcare access and reducing administrative barriers that prevent people from getting the care they need.  

Confidentiality vs. Mandatory Reporting  

One of the most common ethical dilemmas in health and human services is balancing confidentiality with mandatory reporting laws. Professionals—such as social workers, mental health counselors, and healthcare providers—are legally required to keep client information private. However, if they learn that a client is at risk of harming themselves or others, experiencing abuse, or neglect, they may be legally obligated to report the information to the authorities.  

For example, a mental health counselor working with a teenager struggling with depression must decide how to handle statements about self-harm or abuse at home. Reporting could provide the teen with necessary protection, but it might also break their trust and discourage them from seeking future help. Navigating this balance requires careful ethical decision-making, clear communication, and knowledge of both legal requirements and professional ethics.  

Equitable Access to Healthcare  

Another major ethical challenge is ensuring that everyone has access to quality healthcare, regardless of their income, race, or where they live. In Northeast Ohio, health outcomes vary widely based on socioeconomic status and location. For example:

• Individuals in low-income neighborhoods often have fewer nearby healthcare facilities, longer wait times, and higher rates of preventable diseases.

• Racial and ethnic minorities are more likely to face barriers to care, including lack of insurance, distrust in the medical system, and language barriers.

• Patients in rural areas may struggle to access specialized medical services, requiring long travel times for basic care.

Hospitals and other nonprofits—including MetroHealth and Neighborhood Family Practice—work to reduce these disparities by offering mobile health clinics, expanding Medicaid enrollment assistance, and providing sliding-scale payment options. However, limited funding and resources mean that healthcare professionals often must decide where and how to allocate services, making ethical decisions about who gets prioritized when resources are scarce.  

Administrative Burdens  

Even when healthcare services are available, administrative burdens can prevent people from receiving timely care. Administrative burden refers to the obstacles, challenges, and complexities individuals face when interacting with government programs or services. These burdens include:

• Complicated paperwork required to apply for Medicaid, food assistance (SNAP), or other public programs.

• Long processing times for insurance approvals, delaying urgent treatments.

• Confusing eligibility requirements that discourage people from seeking services.

For example, a single parent applying for mental health services for their child might face weeks of waiting due to extensive intake forms, income verification requirements, and insurance pre-authorizations. Meanwhile, a homeless individual trying to access medical care may struggle to provide identification or proof of residency—common requirements for public healthcare programs.  

These barriers disproportionately impact those who already face the greatest health challenges, making it an ethical responsibility for professionals to advocate for simplified processes and help clients navigate the system. Some nonprofits, such as United Way of Greater Cleveland’s 211 helpline, specialize in connecting people with the right services, helping to reduce confusion and improve access to care.  

Ethical Decision-Making in Crisis Situations  

Health and human services professionals often have to make difficult choices during public health emergencies or funding shortages. Consider these real-world scenarios:

• A public health official must decide how to distribute limited resources, such as vaccines or medical supplies, during a disease outbreak. Who gets prioritized—frontline workers, elderly patients, or individuals in high-risk communities?

• A mental health counselor working with an undocumented immigrant must weigh legal risks and ethical responsibilities when connecting the client to public healthcare resources. Should they refer the client to a government-funded program, even if it might put them at risk of deportation?

• A food bank administrator has limited funding and must choose between expanding outreach programs to reach more families or providing more food per family but serving fewer people.

These scenarios illustrate the difficult trade-offs professionals must navigate daily. Ethical decision-making in these moments requires compassion, critical thinking, and a deep understanding of the laws and policies that shape the health and human services sector.  

Ethics in health and human services go beyond following legal guidelines—they involve fighting for fair access to care, reducing bureaucratic barriers, and making difficult decisions about limited resources. Professionals in this field must continually assess how their choices impact the communities they serve, ensuring that those in the greatest need are not left behind.