From rules to encounters: Ethical decision-making as a hermeneutic process

Abstract

• Summary: This article addresses what theories, methods and procedures practitioners ought to adopt in order to resolve ethical problems in service practice. Several approaches are identified from the literature but none are entirely credible in themselves or sufficient for reliably founded ethical decision-making. The article argues that addressing ethical issues should rather be understood as a hermeneutic process. Gadamer’s historically informed hermeneutics is appropriated to lend insight into this process.

• Findings: Approaches to ethical decision-making identified from the literature include: a) approaches based on induction from published ethical codes; b) decision-making algorithms; c) recourse to formal tribunals; d) implicitly following routine agency practices. The place of ‘reflection’ in decision-making is also considered. Taking inspiration from writers in medical ethics, it is proposed that resolving ethically problematic situations should be considered as a hermeneutic process demanding a repeated and progressive quest to reconcile the detailed particularities of the case with complex, competing and evolving moral imperatives. The hermeneutic process proceeds both in relation to the case and in relation to the constantly developing standards and expectations of the professional community and the wider society, and so may be understood as a form of double hermeneutic.

• Applications: Practitioners facing ethically difficult situations should envisage the issue as an incompatibility of frames of meaning, and apply a hermeneutic analysis in pursuit of a ‘merging of horizons’ to address conflicts of ethical views.

Keywords

ethics Gadamer hermeneutics social work

Social workers and ethical issues

It is a commonplace that social workers are faced with morally problematic situations. They have authority to enter the private domain (Clark, 2006) compulsorily on behalf of the state. Some situations may involve breaking fundamental laws that protect the rights and welfare of individuals in society. In other cases it may be behaviour that is so manifestly destructive of the person’s own well-being, or that of his or her family members, that no-one could seriously doubt the need to try and stop it and find a constructive solution. Sometimes the resources that are clearly needed are simply not available.

Although such gross problems may well be distressing to experience and stressful to work with, professionals are not in doubt about what needs to be done in principle even though intervention can be difficult and dramatic. Paradoxically perhaps, it is the everyday cases that are often more deeply puzzling in moral terms. Family members may have poor relationship skills and be damaging each other – but are they so bad that the family living unit should be broken up? An elderly person may live an isolated life, in poor health and at the margins of subsistence – but should they be forced to leave the home where they prefer to remain? Individuals at the margins of society may engage in various dubious or illegal activities – but are they so grave as to require the social worker to report them to the authorities?

In addressing such issues it is common to speak of dilemmas. This risks being a little too simple. Strictly, a dilemma is a choice between two undesirable alternatives, but in most real-life problem situations there are more than just two possibilities to be seriously thought about. For this reason, it is arguably preferable to speak more generally of moral problems or perhaps conundrums. In their book on nursing ethics, Thompson, Melia, and Boyd (2000) suggest moral quandaries. To be in a quandary is to be in a state of uncertainty, puzzlement or indecision. The same authors also suggest that to refer too glibly to ‘dilemmas’ might present a temptation to treat them as incapable of rational solution. But to speak of a ‘problem’ is to imply that evidenced and reasoned solutions can, and should, be sought.

In social work moral problems are often framed in the language of ‘values’; it is assumed that practice ethics are rooted in values; ethics and values are frequently coupled together as closely as the proverbial horse and carriage (for example, Beckett & Maynard, 2005; Parrott, 2006; Reamer, 2006). Here I will follow Banks and use ‘ethics’ to mean ‘the norms or standards of behaviour people follow concerning what is good or bad, right or wrong’ (Banks, 2006, p. 5) and ‘values’ in social work to mean a ‘range of beliefs about what is regarded as worthy or valuable in a social work context’ (Banks, 2006, p. 7). Although there is a small amount of published empirical research about social workers’, and social work students’, values, it is widely scattered in different contexts and countries and highly disparate in terms of foundational theory and methodology. So far therefore, we have only anecdotes and fragments; there is no coherent or dependable corpus of research on what social workers’ values are.

Despite this general lack of research, some clues can be found about the language of dilemmas. In a small empirical study Wilson (2002, 2005) describes community care workers’ experiences in a London borough. Their accounts tell of dealing with difficult cases, abuse, overload, shortage of resources and so forth. Working from these accounts, Wilson proposes:

A dilemma is defined in this paper as a problem, a situation or set of choices presented in a professional or personal context where there is no possibility of a good outcome or resolution … The emphasis here is on situations where values are clear but the choices available to professionals are in conflict with implicit or even overt values. (Wilson, 2005, p. 9)

Banks and Williams (2005) used retrospective discussions of practice experiences to study the language and concepts that social welfare professionals adopt in discussing moral issues in practice. Respondents characterized situations in one of three ways. In some cases, they perceived ethical issues; these referred to a situation seen as difficult but not posing an actual decision or choice for the worker, who was already constrained in terms of practical action. The ethical issue was thus an almost incidental aspect of the story. In some cases, they perceived ethical problems, a situation seen as difficult but where the worker was clear what action needed to be taken. Third, some situations presented ethical dilemmas, where there was seen to be a difficult choice between alternatives.

While it remains an open question whether these findings are representative of the wider community of social welfare professionals in Britain, it is quite striking that the terminology uncovered already suggests a significant discrepancy between the argot of practice and a strict interpretation of ‘dilemma’ as a choice between alternatives. When Banks and Williams’s respondents spoke of issues and problems it would seem, paradoxically, that they were referring to situations where there is not perceived to be a difficult ethical decision to be faced, though there might still be choices to be made. For Wilson’s respondents however, a dilemma represented not so much a difficult choice as an impasse, an aporia. This looser usage, in which a dilemma is just any morally vexing situation, is probably ingrained into the language and culture of social work (for example, Reamer, 1982; Rhodes, 1986). It reflects the looseness of common usage, in which dilemma has come to mean simply any problematic situation where no desirable resolution seems to be available.

Resources and arenas for ethical problem-solving

Granted that social work presents difficult ethical problems – whether dilemmas in a strict sense or otherwise – what theoretical tools and decision-making resources are available to the perplexed beginner or the troubled professional? It is useful first to establish a conceptual distinction between intellectual resources that may be brought to bear on ethical decision-making and the contexts and arenas in which it takes place. We shall go on to consider how they interact.

Resources: Theories, models, methods

Professional problem-solving is usually informed by some kind of theory or model that aims to describe and understand the matter in hand. The prime aim of theory is systematic description and truthful explanation, while models provide simplified representations of complex entities. Theories, of course, frequently incorporate models, and useful models generally embody or translate theory; but as Bhaskar pithily puts it, ‘a theory is a model with existential commitment; that is, a model conceived, and meant to be taken as true’ (Bhaskar, 1978, p. 192). In professional practice, models are offered as prescriptions or templates to be followed in order to pursue stated ends. Theories and models are the stuff of journals, textbooks and official directives. They are also transmuted in popular media and absorbed passively by public and professionals alike.

Ethical problem-solving in professional practice looks to professional codes of ethics and their official bureaucratic cousins, codes of practice, for relevant models. Thus for example, the (voluntary) British Association of Social Workers declares five ‘basic values’ of social work: human dignity and worth, social justice, service to humanity, integrity and competence (British Association of Social Workers, 2002). The (statutory) Scottish Social Services Council sets down six core principles, highlighting rights, trust, independence and protection, respect, public confidence and accountability (Scottish Social Services Council, 2005). Such codes rely for amplitude and authority on the academic literature on social work values and ethics.

Valuable as the broad principles of the codes are for providing a general sense of moral orientation and purpose, by themselves they clearly do not provide the answers in specific cases. Recognizing the complexity and hidden hazards of ethical decision-making, quite a few authors have recommended following a series of steps. Such models or decision-making algorithms commonly comprise about six to eight steps from identifying the problem, to deciding on the best course of action, to evaluating the outcomes. As McAuliffe and Chenoweth remark, ‘ethical decision making models and frameworks that rely on a linear structure with clearly defined steps are quite common in the literature of a number of disciplines’ (McAuliffe & Chenoweth, 2008, p. 40).

Table 1 presents a simplified summary of the main stages of seven recent step-by-step models for ethical decision-making in social work, nursing and bioethics (see also Clifford & Burke, 2009; Corey, Corey, & Callanan, 1998; Gracia, 2003; Leever, DeCiani, Mulaney, & Hasslinger, 2002; McAuliffe & Chenoweth, 2008; Reamer, 2006; Thompson et al., 2000). The table displays, as column headings, the identified steps of problem-solving in the seven selected models. The numbers in the body of the table show the position of the relevant step within a particular model. Thus for example, ‘state or identify the problem’ appears as the first step in four of the models, while ‘review ethics codes or ethical theories’ appears variously as the second, third, fourth or fifth step in several of the models.

Table 1.

Main features of seven stepwise models for ethical decision-making

Authors	Main field	State/ identify problem	Check facts	Identify issues	Review ethics codes, ethical theories	Consider values	Apply laws	Apply theories	Obtain consultation	Consider alternatives	Identify consequences	Decide action	Evaluate conclusions/ outcomes
Corey et al. (1998)	social work	1		2	3		4		5	6	7	8
Thompson et al. (2000)	nursing	2	1	3	4					5	6	7	8
Leever et al. (2002)	social work	1	2	4			4			3, 5		6	7, 8
Gracia (2003)	bioethics	1	2	3, 4		5				6, 7		8	9
Reamer (2006)	social work			1	3(a), 3(b)	3(c)		3(d)	4	2		5
McAuliffe & Chenoweth (2008)	social work	1	3	2	3	3	3	3	3	4			5
Clifford & Burke (2009)	social work			1	2(b), 5	6(a)	2(a)		3	4

Note: Numbers in the table cells refer to the stages of the relevant model; some simplifications applied.

Some authors (e.g. McAuliffe & Chenoweth, 2008; Thompson, 2000) take the same idea of a sequence of steps but make a join from the end back to the beginning, thus creating a circle or spiral. They emphasize the cyclic, iterative character of decision-making. A further relaxation from the idea of a specific sequence is recommended by those authors who offer a range of points for consideration, but not for following in any necessary particular order (e.g. Bowles, Collingridge, Curry, & Valentine, 2006).

Contexts

Problem-solving takes place in a range of social contexts or arenas. At one extreme, we have the imagined solitary thinker enwrapped in her own world. At the other extreme lie the court of law and the international conference – essentially social events in which the resolution is sought in a formalized dialectical process.

An important arena for resolving ethical issues in service practice is the formal tribunal, in the Shorter Oxford English dictionary’s sense of ‘local boards of officials empowered to settle disputes, especially between an individual and a government department’. Examples in the UK include adoption panels, child protection committees, children’s hearings (in Scotland) or allocation panels for community care resources. This category also includes certain functions of courts of law. In ideal terms, such bodies are characterized by formally mandated or recognized responsibility, armed with legal or administrative authority. They provide a forum in which to consider different options and identify the preferred course of action; they shift, to some extent, the responsibility for decisions away from the practitioners immediately concerned with a case, and place it with disinterested adjudicators. These features of formal tribunals make them especially valuable for deciding problematic cases. In addition, their decisions accumulate as a body of formally authoritative precedent and recognized good practice that can inform, or bias, practitioners dealing with similar kinds of cases in future.

Important as formal tribunals are, the great majority of ethically laden decision-making never gets that kind of attention. On the whole, it is the province of custom and practice, interpreted by workers, by local supervision and management, and backed by local and wider tradition. As in every occupational context, social work agencies accumulate a store of informal rules and routine practices that inform workers’ everyday actions, often unconsciously. The arena is the daily life of the organization, in the micro-interactions of colleagues, in the supervision session and the team meeting, in management and committees. Part of the process of becoming familiar with a service context is learning everyday practice, the usual – and usually unspoken – rules. Scourfield and Pithouse (2006), for example, identify how in the ‘Uplands’ team described in their ethnographic study of a statutory child welfare agency in the UK, some kinds of work – including work with sex offenders and direct work with children – were seen as ‘warranting the application of specialist professional knowledge/theory, whilst other areas of work were seen as more routine and susceptible to mainstream skills and competences’ (p. 332).

Shortcomings of theory in ethical decision-making

How then do practitioners address ethical problems, and how should they? This is clearly a particular aspect of ‘how professionals think in action’, to borrow the subtitle of Schön’s (1983) famous study. Turning first to the decision-making algorithms exemplified above, a moment’s inspection shows that they are in essence entirely generic problem-solving models of the kind to be found in any practical field: define the problem, consider the relevant resources, identify and evaluate the options, reach a conclusion, implement the action and evaluate the results. They may (and should) be informed by ethical theories and professional codes. This way of thinking is nicely illustrated by Bowles and colleagues’ charming, but alas science-fiction, suggestion of an electronic EDM (for ‘ethical decision-making’) smart card with which practitioners of the future would be able to instantly resolve all ethical issues (Bowles et al., 2006).

Despite the ubiquity of problem-solving models as textbook prescriptions however, there is scant evidence that social workers (or other professionals) actually approach and solve ethical issues in this fashion of linear logic. It says nothing about the inspired guesses or flashes of intuition that very often precede the logical demonstration of a preferred outcome. It is deaf to the voices of values and emotions that shape our ethical sensibility. It is separated by a great epistemological gulf from much of ethical theory, except perhaps from some varieties of act utilitarianism. Indeed, as Banks and Gallagher conclude in their exposition of a virtue-based ethics for health and social care: ‘there is no algorithm that will resolve the dilemmas of professional practice … ’ (Banks & Gallagher, 2009, p. 81).

More credible accounts of problem-solving emerge from a broadening stream of research on ‘practice wisdom’ that has in large part arisen from, or as a reaction to, Schön’s work. Sheppard (1998), for example, argued for ‘practice validity’ rather than mere academic legitimacy as the touchstone of practically useful knowledge. O’Sullivan (2005) aims to rehabilitate the concept of practice wisdom from the confusion that surrounds it.

It is research that is predominantly ethnographic in character and interpretivist in its basic assumptions that offers the most plausible accounts of clinical judgement and problem-solving in practice (see for example, Taylor, 2006; Taylor & White, 2001; White, 2009; White & Stancombe, 2003). From such research there seems no reason to doubt that decision-making on ethical issues follows essentially the same processes as the great majority of all decision-making in social work. While it aspires ideally to be informed by theory, it is usually inaccessible to direct theoretical scrutiny; practitioners are guided by implicit learning from experience rather than theoretical conclusions explicitly worked out from first principles. Routinized professional decisions tend to escape the rigour of scrutiny that they arguably need. The routinization of decisions and practices may well, however, be troubling to new and junior workers, or students, who are struck by possible ethical issues that experienced workers have become inured to, or perhaps deny. The accounts of students are rich in the surprise, discomfort and shock they experience when they find themselves doing or witnessing things they had not fully anticipated, such as manipulating the flows of information to induce certain responses in clients, or imposing statutory restraints on freedom.

A major (and related) current theme in the literature of how practitioners apply knowledge and evidence to practice is the metaphor of reflection. It carries connotations of retrospective self-awareness and prospective reflexivity, of pausing and revisiting, of balanced, thoughtful and responsive relations as opposed to precipitate and unconsidered behaviour. Reflection (as an activity of thought) and reflectivity or reflexivity (as intellectual and practical virtues) are widely agreed to be constitutive of any serious endeavour. In a comprehensive literature review, Fook, White, and Gardner (2006) (Fook is a noted exponent of reflective practice in social work; also see Fook, 2002), observe ‘burgeoning interest in the ideas of reflective practice and critical reflection over the last few decades … explosion of interest and therefore literature on critical reflection’ (p. 3). Fook et al. comment that ‘Indeed, conducting a literature review has been extraordinarily difficult in what appears to be a messy and complex field in which traditional disciplinary boundaries and shared criteria for academic rigour do not always apply’ (p. 4). The review notes a plethora of definitions, models and methods but offers only the following conclusion of somewhat baffling circularity:

In its fullest sense, then, reflective practice or critical reflection appears to apply to the use of reflective abilities in the scrutiny and development of practice. This therefore implies the use of a framework for a reflective process involving different levels and stages, with one stage at least focused on the application of reflective learning to practice itself. (p. 12)

D’Cruz, Gillingham, and Melendez (2007) also undertook a literature review on reflexivity in social work, and also noted the very wide range of usage and rather inconsistent application of terms such as (critical) reflection and (critical) reflexivity. They discerned three ‘variations’ on the meaning of reflexivity, which can be summarized as follows: i) as an attribute of the individual that enables him/her to make life choices; ii) as an approach to professional practice that questions how knowledge is generated, and how relations of power influence the process; iii) as an approach to practice that acknowledges the mutual influence of thoughts and feelings. However, in common with White, Fook, and Gardner (2006), it is notable that reflection on specifically ethical questions is not a question addressed in the review (D’Cruz et al., 2007).

If ethical issues have not come prominently into the sights of the general theorists of reflection, some writers on practice ethics have nonetheless noted its relevance. Banks recommends ‘developing a capacity for critical reflection and reflexivity (Banks, 2006, p. 159), while Parrott recommends ‘critical self-reflection’ (Parrott, 2006, p. 79). Bowles and colleagues (2006, pp. 211–213) picture the ‘circle of reflection’ as a wheel with personal values at the hub and various duties and obligations around the periphery. Clifford and Burke (2009) require ‘reflexive thinking’ and ‘reflexivity’ as essential for anti-oppressive practice, putting the main emphasis on the worker’s stance towards her own and others’ attitudes and values.

Since human beings can no more stop themselves from reflecting than they can from dreaming, reflection and its cognates will certainly figure in any account of ethical decision-making. No-one would argue for an unreflective approach in difficult cases. Nevertheless, reflection is an entirely general feature of thought about difficult problems; it remains unclear exactly how invoking it adds to the analytical grasp of the practitioner facing difficult moral issues.

I conclude that the process of practical reasoning about ethical decisions is inadequately conceptualized in any of the frameworks outlined above. Ethical decision-making cannot be effectively addressed by following stepwise algorithms. The principles and values encapsulated in standard codes are effectively mute without a level of elaboration that is rarely encountered in the real-life situation. In the remainder of this article I argue that ethical decision-making should better be conceived as a hermeneutic process. I will set out a version of hermeneutic reasoning especially derived from the work of Gadamer, and will explore its implications for professional action. There is some affinity between seeing ethical issues in practice as primarily requiring a reflective approach, and the general approach of hermeneutics; but while there are passing hints of a filiation to hermeneutics in some of the social work writings on reflection (for example, White, 1997), the connection has not been set out in any depth. The arena and context of decision-making remain absolutely crucial to the process of finding good resolutions; they provide the stage for a hermeneutic approach.

Hermeneutics and professional practice

The general idea of hermeneutics

What is meant by ‘hermeneutics’? The root idea is interpretation; in earlier times, it referred to the interpretation of religious texts. The role of interpretation was to enlighten the reader as to how linguistically difficult, or historically or culturally remote, scriptures might be rendered or translated, so to speak, into terms intelligible and morally meaningful for the present-day context.

In contemporary social theory hermeneutics denotes an approach to understanding social interaction that foregrounds and treats as primary the meanings with which historical, social and cultural phenomena are imbued by reflexive, self-understanding and self-reconstituting human subjects. Hermeneutics is a foundational element of the interpretive schools of social science; as a mode of understanding and method of analysis it is often counterposed to the basic assumptions of empiricist and realist social science (see for example, Outhwaite, 1996). Thus the scope of hermeneutics has now expanded beyond its original concern with texts: as Giddens put it, ‘Hermeneutics, I wish to claim, does not find its central range of problems in the understanding of written texts as such, but in the mediation of frames of meaning in general’ (Giddens, 1976, p. 64, emphasis added). The Stanford encyclopedia of philosophy comments:

With the emergence of German romanticism and idealism the status of hermeneutics changes … Now hermeneutics is not only about symbolic communication. Its area is even more fundamental: that of human life and existence as such. It is in this form, as an interrogation into the deepest conditions for symbolic interaction and culture in general, that hermeneutics has provided the critical horizon for many of the most intriguing discussions of contemporary philosophy … (Ramberg & Gjesdal, 2009)

The aim of hermeneutics is thus to show how we are to secure understanding of the social world. Our being in the social world is inseparable from language, indeed inconceivable without language, and therefore social actors face the constant task of the interpretation of texts both historical and contemporary. The hermeneutic interpreter is herself immersed in the social worlds that she partly shares with the subjects of inquiry; this immersion, far from being a disadvantage to research, is essential to understanding the world of the observed subjects; without partly sharing this world, the observer would be totally unable to make any sense of it.

Gadamer and historically affected understanding

In his master work Truth and method, Gadamer (2004) describes, prescribes and exemplifies the processes of intuitive and analogical reasoning that enable human subjects to make sense of the world in a way necessarily conditioned by, but not bound to, their particular historical position within it. Gadamer particularly maintains that we can never entirely escape the influence of our own past experience, the historical context in which it is embedded, and its residue of beliefs and understandings; our understanding is necessarily always a historically conditioned understanding.

Gadamer adopts and revises Heidegger’s conception of the hermeneutic circle. ‘A person who is trying to understand a text is always projecting. He projects a meaning for the text as a whole as soon as some initial meaning emerges in the text’ (p. 269). The ‘fore-projections’ that emerge are constantly revised.

The process that Heidegger describes is that every revision of the fore-projection is capable of projecting before itself a new projection of meaning; rival projects can emerge side by side until it becomes clearer what the unity of meaning is; interpretation begins with fore-conceptions that are replaced by more suitable ones. This constant process of new projection constitutes the movement of understanding and interpretation. (p. 269)

In trying to understand a text the interpreter must be guided by the objects of his gaze themselves and avoid being distracted by those that originate in the interpreter himself. We must remain open to the meaning of the text and be prepared to forget ‘all our fore-meanings concerning the content and all our own ideas’ (p. 271). A person trying to understand a text is prepared for it to tell him something; he must be sensitive to the text’s alterity. This kind of sensitivity involves neither ‘neutrality’ with respect to content, nor the extinction of one’s self, but the foregrounding and appropriation of one’s own fore-meanings and prejudices. The important thing is to be aware of one’s own bias.

Concomitantly with his insistence on the historically conditioned nature of hermeneutic understanding, Gadamer radically reinstates ‘prejudice’ (Vorurteil – which can also be rendered as ‘prior judgement’ or ‘prejudgement’) as a condition of that understanding. ‘The recognition that all understanding inevitably involves some prejudice gives the hermeneutical problem its real thrust … There is one prejudice of the Enlightenment that defines its essence: the fundamental prejudice of the Enlightenment is the prejudice against prejudice itself, which denies tradition its power’ (pp. 272–273). Prejudices, in fact, are the very conditions of understanding and the challenge is to distinguish ‘legitimate prejudices from the countless others which it is the undeniable task of critical reason to overcome’. As Dunne puts it in his eloquent exegesis:

Gadamer removes any secure vantage point outside or over against his text that an objectivizing interpreter might have supposed himself to be in possession of. He shows that understanding is an event that happens within a relationship of vulnerability to text, and that it arises out of a fusion of the contexts of both interpreter and text in one fluid medium of an effective tradition … (Dunne, 1997, p. 105)

Gadamer amplifies the role of history in forming the capacity for understanding by means of the notion of ‘historically effected consciousness’ (wirkungsgeschichtliches Bewusstsein), or consciousness of being affected by history. If we are trying to understand a historical phenomenon from the historical distance that is characteristic of our hermeneutical situation, we are always already affected by history. In all our understanding, the efficacy of history is at work. We must become conscious of effective history. Historically effected consciousness is an element in the act of understanding itself.

To describe the process of achieving hermeneutic understanding Gadamer deploys the imagery of ‘horizon’. The analyst’s situation can be understood as a standpoint that both enables and limits the possibility of vision. Every standpoint has its horizon: ‘The horizon is the range of vision that includes everything that can be seen from a particular vantage point’ (p. 301). Understanding tradition requires a historical horizon. But we do not acquire this horizon by transposing ourselves into a historical situation. Rather, we must always already have a horizon in order to be able to transpose ourselves into a situation. Transposing ourselves always involves rising to a higher universality that overcomes not only our own particularity but also that of the other. There is no more an isolated horizon of the present than there are historical horizons which have to be acquired. ‘Rather, understanding is always the fusion of these horizons supposedly existing by themselves’ (p. 305; emphasis in original). It is part of the hermeneutic approach to project a historical horizon that is different from the horizon of the present. According to Malpas in the Stanford encyclopedia of philosophy (Malpas, 2008), Gadamer views understanding as a matter of negotiation between oneself and one’s partner in the hermeneutical dialogue such that the process of understanding can be seen as a matter of coming to an ‘agreement’ about the matter at issue. Coming to such an agreement means establishing a common framework or ‘horizon’ and Gadamer thus takes understanding to be a process of the ‘fusion of horizons’.

Hermeneutics in professional ethics: The example of medicine

The possibilities of hermeneutics have been explored to a certain extent in the field of medical ethics. Medical ethics is of great relevance to social work for a number of reasons (Downie & Telfer, 1980). Social work shares with medicine a primary focus on promoting the well-being of the individual person who as a patient or client is likely to be in an incapacitated or vulnerable condition. Indeed individuals are often both patient and client at the same time. Social work also shares with medicine the professional’s responsibility for safeguarding the interests of the wider community. Medical ethics, with its tradition dating back more than two millennia, is the archetype for all the disciplines of ethics in the personal service professions that have emerged in the last few decades. Familiar precepts such as confidentiality and the avoidance of exploitative relationships are directly derived from the medical tradition. Medical ethics, however, has the clear advantage over social work of a very much more substantial base of scholarship, research and institutional application. While we may certainly acknowledge that social work also shares ethical concerns with legal practice, counselling and psychotherapy, education, allied medical professions and other fields, the example of medical ethics is especially pertinent for social work.

Boyd (2005) suggests that there are three main contemporary approaches to professional ethics in medicine. The first and currently predominant, principlism, aims to establish core moral principles that need to be applied, and sometimes balanced, in medical decision-making. The best known exponents are Beauchamp and Childress (1994) with their four principles of autonomy, non-maleficence, beneficence and justice. The second approach is virtue ethics, which focuses on the qualities of the practitioner as a moral agent. The third approach, according to Boyd, focuses on ‘perspectives’, or the history of the case as seen by the participants. This hermeneutic approach requires all the participants to be involved in listening to the others’ story. Hermeneutics has attracted some attention as a way of characterizing medical understanding, as the following selections from the literature will show.

Leder (1990) argues for a hermeneutic conception of medical practice. The ‘person-as-ill’ can be considered as the ‘primary text that situates the clinical encounter’. Four ‘secondary texts’ represent key aspects of the clinical encounter: the ‘experiential text’ comprising the patient’s experience, symptoms and attempts to interpret them; the ‘narrative text’ focusing on the clinical history; the ‘physical text’ on the ‘reified body of the patient’; and the ‘instrumental text’ which conveys the results of physical and diagnostic texts. Leder claims that ‘medical help is most frequently sought when there is a felt sense of hermeneutic incompletion’ (Leder, 1990, p. 12). Leder’s depiction of the centrality of interpretation in medical practice is close to that of Hunter, who explains:

Clinical medicine shares its epistemological predicament and its methods of knowing with history, law, economics, anthropology, and other human sciences less certain and more concerned with meaning than the physical sciences. (Hunter, 1996, p. 229)

Consequently,

in the day-to-day diagnosis and treatment of disease in sick people, clinical reasoning is a hermeneutic or interpretive process. (Hunter, 1996, p. 232)

While Leder did not specifically address ethical questions, Thomasma explicitly argued for ‘Clinical ethics as medical hermeneutics’, on the basis that the reasoning patterns of ethical judgement are similar to the reasoning patterns of clinical judgement. He explains:

What makes interpretation hermeneutical is an historical problematic, that is, an intense realization of the historicity or conditionedness of any human action or human being. This intense realization is transcribed into a problem of a boundary or chasm between the interpreter and the interpreted. Both are bound up in the historical conditions of their existence. There is a boundary to be transcended, if possible, in the hermeneutical act … My thesis is that clinical ethics is hermeneutical because it involves interpretation across all of the boundaries that naturally occur in an imbalanced relationship between physician and patient. (Thomasma, 1994, p. 96)

This stance follows from the philosophy of medical practice set out at length in his much earlier collaborative work with Pellegrino (Pellegrino & Thomasma, 1981), a key inspiration for modern medical hermeneutics.

Gadamer’s work has specifically inspired two further writers on medical relationships. Árnason claims that patient–professional relationships have conventionally been presented as characterized either by paternalism or by an emphasis on patient autonomy. However, both of these approaches fail because ‘the patient–professional relationship is not regarded as inter-personal and dialogical’. In a dialogical relation, ‘the focus is on the relationship between the two partners engaging in a shared deliberation resulting in a joint decision which is based upon mutual trust’ (Árnason, 2000, p. 17). Árnason goes on to develop an account of conversation derived from Gadamer’s hermeneutics. Árnason cautions, however, that the value attributed to tradition and authority in Gadamer results in an inherent tendency to paternalism and a lack of sensitivity for individual self-determination.

Svenaeus also borrows Gadamer’s idea of dialogue-based hermeneutics as a model of the ‘interpretive structure of medical practice … The clinical encounter can be viewed as a coming-together of the two different attitudes and lifeworlds of the doctor and patient – in the language of Gadamer, of their different horizons of understanding – aimed at establishing a mutual understanding, which can benefit the health of the ill party’ (Svenaeus, 2003, p. 416). Thus ‘the important thing for the good clinical hermeneut to remember while carrying out his interpretation is to be open to the horizon of the patient’ (p. 426). Svenaeus further draws on Gadamer’s writings on health, in which Gadamer posits that health is a certain way of being-in-the-world. This requires the doctor to gain an understanding of the individuality of the patient; the doctor ‘needs to address the questions of the good life and of the meaning of life for this particular person’ (p. 422), and this is something that the standard theories of medical ethics neglect.

The exploration of hermeneutics in clinical medical ethics is, then, very much an ongoing project. While perhaps it has not greatly impacted on the dominance of principlism, hermeneutics raises fundamental questions of understanding and method which principlism does not have the resources to satisfy, deny or refute. The recent work of Steinkamp and & Gordijn (2003) is an interesting example of how different approaches to ethical decision-making in clinical practice can learn from each other and perhaps be combined.

Towards a hermeneutic approach to ethical decision-making in social work

In social work the predominant approach to ethical decision-making is not dissimilar from that in medicine. The standard professional codes and much of the literature comprise what is in effect also a species of principlism. While the traditional values of social work could hardly give a higher place to the uniqueness of the client within a personalized helping relationship, its recommended methods of ethical decision-making seem unpersuasive in terms of practical reasoning in action.

How might a hermeneutically inspired approach improve understanding? I do not intend any precise and systematic application of Gadamer’s (or any other writer’s) theory. Instead, what is offered here is a simplified, somewhat freehand borrowing and adaption from the hermeneutic tradition, particularly as developed by Gadamer. This suggests three cardinal principles to illuminate making ethically challenging decisions in social work. i) The first is the deep appreciation that all understanding is historically conditioned. Our consciousness – our prejudices, in Gadamer’s sense – are rooted in the soil of culture which we cannot only not escape, but without which we would be incapable of any understanding in the relevant senses. We can trace, for example, the multiple roots of social work’s discourse on ‘values’ in religious belief, in moral and political philosophy, in the emergence of modern science, in clinical practice, and so forth. While the traditional discourse may have a perennial aspect, it has been constantly redefined and reformed. To speak, say, of self-determination in the contemporary context of improved life choices and chances for individuals with disabilities is to entertain a very different problematic from that of Biestek (1961) in his original formulation for social work. To fully engage with ‘self-determination’ is to nurture a live and ever-deepening interpretation of the multiple layers of meaning, often only dimly perceived, half-remembered, contradicted or partly distorted, that circulate in the communities of practitioners and in the client publics. However, it is our ‘prejudices’ about self-determination that constitute the very conditions of our understanding of it; there is ‘no secure vantage point’ that can guarantee a privileged view of it.

Historically conditioned understanding is also inherently biographical, of course. Our historically conditioned consciousness embraces our own biography as well as the world of the other, which we are trying to understand. The hermeneutic gaze is informed by ‘an intense realization of the historicity or conditionedness of any human action or human being’ (Thomasma, 1994, p. 96). A core tradition in social work (borrowed to a large extent from psychoanalysis) emphasizes the individuality of the worker as well as the uniqueness of the client. The practising professional is necessarily shaped out of her own lived experience, and to be an effective helper needs insight into her own formation with its potentials for strength and weakness. Professional helping is an encounter between unique individuals; there can never be such a thing as a completely standardized social worker, or a uniform unit of social work demand.

ii) The second principle to be appropriated concerns the circular, or perhaps spiral, nature of understanding in its encounter with the ‘text’. Every act of understanding the situation of the other is tentative and provisional. As we strive to attend to the ‘text’ that is the other, we are open to its meanings that we grasp through our fore-understandings, and which must themselves be successively replaced as we deepen our understanding. Every ‘reading’ of the ‘text’ inspires a new, tentative understanding, itself liable to be replaced by yet another reading. ‘Rival projects’ emerge, mutate and dissolve until our understanding reaches equilibrium – usually only a temporary equilibrium, to be upset by new information and new circumstances. The metaphor of reflection appears commonly in descriptions of this process; it conveys the idea that good understanding of the other entails one’s own self-understanding; it is fluid and responsive; it seeks for insight and reflexivity, for objectivity born out of, not denying, one’s own subjectivity.

The arena of hermeneutics is not only symbolic communication, but human life and existence as such. When we approach a clinical or personal service encounter we should aim to grasp the individual, his biography, his situation as a text. Writers in medical ethics have identified several texts that preoccupy the clinician, such as the presenting symptomatology, the scientific understanding of the underlying disease process, and so on. The principal text for Leder (1990) was the ‘person-as-ill’. There is perhaps much less agreement in social work about what the relevant texts would be. Nevertheless, Leder’s identification of the ‘person-as-ill’ carries an obvious resonance with social work’s ‘person-in-situation’ (in any of many formulations). There can also be little doubt that the ruling legal and administrative framework is a key text for modern social work.

iii) The third principle places at centre stage that the search for understanding is a mutual process that is conducted through dialogue; it refuses any notion that the understanding of the professional should have superior epistemological status over the unenlightened inclinations of the client or other relatively powerless subject. This is what Árnason referred to as a ‘dialogical’ relationship. Paradoxically, it is our prejudices that allow us to move towards better mutual understanding, but we must be constantly willing to discard and replace them. At minimum we must understand the other’s horizon, ‘where he is coming from’ (Gadamer, 2004, p. 302). Ideally we aim to so enlarge our mutual understanding that we move toward the fusion of horizons. Moving towards the fusion of horizons requires a mutually negotiated mediation of frames of meaning: that is to say, to engage in constructive comparison of the whole conceptual apparatus that makes the individual’s world intelligible to him or her self.

The hermeneutic process of working towards understanding and resolving discontinuities of frames of meaning applies not only to the horizons of the actors in the case, but also to the conceptual frameworks that we use as tools to seize and analyse ethical problems. This is a kind of double hermeneutic, though not quite in Giddens’s original sense. Giddens argued that in sociology one must undertake the hermeneutics of any general theoretical scheme of social explanation, but in addition sociology is faced with ‘a universe which is already constituted within frames of meaning by the actors themselves, and reinterprets these within its own theoretical schemes, mediating ordinary and technical language’ (Giddens, 1976, p. 162) using descriptive metalanguages. So too in professional ethics: there is what we might call the internal hermeneutics of its professed theories and values, and the external hermeneutics of comprehending the world of the others with whom we engage in the professional encounter.

How might a hermeneutic approach allow us to reconceptualize ethical decision-making in social work? We may say that ethical quandaries in professional practice should be construed as conflicts of frames of meaning. Take for example an ethical dilemma reported by Papadaki and Papadaki (2008). A social worker in Crete was working with a childless couple who were caring for a six-month old baby, which they wished to adopt. During the process the wife unexpectedly became pregnant. Organizational regulations did not permit couples with a biological child to become adoptive parents. The couple were even willing to consider going for an abortion so as not to lose the chance of adoption. The worker said: ‘I was in a fix. Should I propose stopping the adoption procedure or should I keep the pregnancy secret?’ (Papadaki & Papadaki, 2008, p. 171).

Several conflicting frames of meaning are at work in such a case. The perspective of the adoption organization is perfectly intelligible: babies for adoption are in short supply and arranging adoptions is costly; unfortunate childless couples are more deserving to become adoptive parents. The parents’ perspective readily attracts sympathy: so desperate are they to keep the baby that they will go to the length of considering abortion, a deeply deprecated practice likely to attract moral and civil censure as well as considerable psychic pain. The worker’s professional world is delineated by obligations of confidentiality towards the clients, truthfulness in handling their affairs and formal accountability to her employer – obligations which in this instance are in conflict (Clark, 2008). Indeed these are historically conditioned ‘prejudices’ that both enable the actors’ understanding of the ‘fix’ and to some extent also imprison them, too.

Stories of ethical problems in practice are often framed in terms that imply or represent that the end of a road has been reached, that there is no escape from a painful endpoint in which at least one important good has to be sacrificed. The reader, or colleague or supervisor, is in effect invited to try and solve a kind of puzzle in which the nature and terms of correct potential solutions have been defined in advance by the conceptual framework in which the problem has been set. The leading conceptual framework remains, as already noted, some form of principlism, and the leading model of application is the stepwise problem-solving model. If there does not appear to be any solution that meets the terms of the puzzle then one is left with little resort but to choose intuitively or randomly. But what is happening here is a premature rush to the exit. This is often seen from beginners and students who feel under an expectation to solve the problem immediately. What more experienced practitioners learn is that when in a quandary it is better to avoid being rushed to the exit if at all possible. The problem needs to reflected upon and reframed; this is the hermeneutic challenge of interpreting and re-interpreting the text. The professionals meantime have to live creatively with the discomfort of no immediately available solution, as well as the discomfort that the time available to find a solution is often strictly limited.

At the end of the day, no good outcome is reached by simply trying to impose the preconceptions of one or more actors or institutions over another. The parties involved need to be brought closer together in dialogue, not driven to further retreat behind increasingly entrenched positions. They will seek to envision each others’ horizon and to achieve at least a working understanding of each others’ pre-judgements and a working compromise of frames of meaning, relevance and value. Ultimately, they will aspire to the fusion of horizons, while accepting that such a goal may lie only at the end of the rainbow.

Conclusions

The prescriptions for ethically difficult decision-making offered in the literature predominantly suffer from a kind of reductionism. Facts that can only be partly known and issues that are only dimly and imperfectly apprehended are represented in the idealized models as fully knowable. Moral questions that in reality are suffused with ineradicable ambiguity, and over which a broad consensus is simply not obtainable, are represented as susceptible of clear and strongly founded resolution. Moral decision-making in service practice is represented as essentially no different from any other standard problem-solving activity, and amenable to the same general disciplines. The hidden assumption here is that there is, in effect, a demonstrably right answer that merely requires a little working out; if we carefully follow the prescribed method, then all will be well.

Against this positive fairy story is the surely commonplace experience that when faced with moral quandaries in service practice, there simply is no useful answer that can be worked out from the prescribed manual or procedure or looked up in the back of the textbook. I have argued that this dissonance follows from what is essentially an epistemological category mistake – to treat questions of human value and social purpose as if they were matters of technical rationality. Nevertheless, technical problem-solving cannot suffice to enlighten us about how to grasp the social world, comprehend our identity and realize our being in community.

Medical ethics addresses problems that in many ways are analogous to those faced in social work. Taking a lead from a number of writers in medical ethics who have drawn inspiration from phenomenology, I have proposed that Gadamer’s account of hermeneutic understanding offers a fruitful way of conceptualizing the process of moral problem-solving in social work service practice. Gadamer especially stresses how our understanding is inescapably a historically conditioned understanding. The hermeneutic process of constantly reviewing and reforming our understanding of the text – or the person-in-situation – before us provides a better footing for moving towards a resolution of the ethical issues embedded in practice situations.

The universal popularity of the algorithms found in textbooks and the plethora of rulebooks favoured by formal organizations suggests they may sometimes be useful. At the very least, any tool, however blunt or clumsy, may sometimes turn out to have some unexpected heuristic value. It is noteworthy that problem-solving algorithms quite often propose a circular, iterative methodology, and this metaphor of circularity also famously appears in the hermeneutic circle. So let us grant the possibility that algorithms may help us to get better engaged in the ethical problem. What must be avoided, however, is accepting the closed logic of technical-rational problem-solving. In the difficult cases that are commonly characterized as ethical dilemmas, this will lead to outcomes that at best will be acceptable to only some, and not all, of the participants and interests involved. Instead of mutual resolution of ethical difficulties in dialogue the result is the imposition of power by the stronger over the weaker. Gadamer’s conception of the ‘fusion of horizons’ is a better metaphor for the goal of ethical problem-solving. This correctly locates the resolution of ethical issues as a problem of historical and hermeneutic understanding, rather than as a matter of knowing the right technical rules.

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