CONSCIENTIOUS REFUSAL IN SCHOOLS OF SOCIAL WORK: RIGHTS, REMEDIES, AND RESPONSIBILITIES

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1 CONSCIENTIOUS REFUSAL IN SCHOOLS OF SOCIAL WORK: RIGHTS, REMEDIES, AND RESPONSIBILITIES Jay Sweifach Yeshiva University INTRODUCTION Conscientious objection (CO) is a deeply held religious or moral conviction that precludes an individual from participating in an act that is perceived to be against their beliefs. The most familiar illustration is military CO, in which an individual refuses to participate in military service on grounds of freedom of thought, conscience or religion. CO has been extended to various professions, such as medicine, nursing, and pharmacy, allowing professionals to opt-out of participating in healthrelated services which are found to be personally, morally, or religiously objectionable. One lesser-known example of CO concerns students who refuse to participate in educational activities which conflict with moral/ religious or personal worldviews. This paper reports on a national study which explored CO by students in schools of social work. Research questions focused on the perceptions of social workers about social work students who opt-out of attending class or other school activities, as a result of a conflict with a religious or moral worldview (e.g., should social work students who claim conscientious objection, be excused from classes when material being presented conflicts with his/her moral/religious beliefs). An Internetbased survey, was used to reach a broad spectrum of social work practitioners and educators (n = 3,300) across the United States. Clarification of Terms A conscience clause (also termed objector legislation, noncompliance clause, opt-out clause, refusal clause, religious exemption, and abandonment law) is a policy statement or provision, typically related to health care, which exempts professionals from providing or covering health-related services which are found to be personally, morally, or 37

2 38 Teaching Ethics, Fall 2012 religiously objectionable. These provisions, drawn from philosophical, legal, and theological perspectives (Anderson, Bishop, Darragh, Gray, Nolen, & Poland, 2006) may be expressed in a number of different ways; for example, a physician who refuses to prescribe birth control to unmarried women, a nurse who refuses to assist in an abortion, or a pharmacist who refuses to dispense the morning after pill. For the purposes of this paper, the focus will be on conscious objection by social work students who find course material or classroom activities objectionable. Opting-Out in Educational Settings During the late 1800s, the first opt-out cases began to appear in educational settings, and involved excusing dissenting students from prayer (DelFattore, 2004). Another early expression of opting out in schools, involved the refusal of Jehovah s Witnesses to pledge allegiance to the flag (Witham, 2002). Over the years, public school and college students have continued to opt-out of participating in an array of school activities, including dissections, sex education, and the teaching of evolution. Although most states and many professional associations allow professionals to opt-out of practices to which they object, the public has come to expect that professionals are prepared and committed to uphold and support the rights, values, and interests of clients/patients. These expectations derive from ethical principles of beneficence (promote the welfare, health, and wellbeing of others), nonmaleficence (do no harm), and autonomy (helping to further the unique interests of clients/ patients). These principles are central to most professional ethical codes. The public also expects that professionals are educated, up to date in knowledge and skill, are properly qualified to meet the unique needs of patients/clients, and have the capacity to provide compassionate and quality care to all, when and where required. These expectations tend to be implied by virtue of the professional s education, credentials, and experience. Some commentators assert that these expectations become questionable when students opt-out of learning about professional practices and procedures (because they are found to be objectionable) especially given expectations by the public that the professional has expertise and competence in their realm of practice. For example, the literature reports that some medical students have refused to attend classes about alcohol-related disorders, or sexually transmitted diseases

3 J. Sweifach: Conscientious Refusal in Schools of Social Work: Rights, Remedies, and (Peverly, 2007; Wicclair, 2010); law students have refused to answer questions about homosexuality on the bar exam (Goodison, 2008); and pharmacy students have refused to participate in training on contraceptive drugs (Franck, 2004). In each of these situations, gaps in knowledge could potentially affect future clients/patients. Most health-related graduate school accrediting bodies do not appear to have policies that guide students and faculty when issues related to CO arise. Only medical school accrediting bodies have some guidelines about CO. The Association of American Medical Colleges (AAMC), which represents United States medical schools suggests that when medical students object to educational activities which conflict with religious or personal worldviews, students may request a conscience based exemption (CBE) to be excused from classes or activities. The Accreditation Council for Graduate Medical Education (ACGME), which accredits post-md training programs allows students to opt-out of certain types of training (like abortion) if the student has a religious or moral objection. There does not appear to be consistency in how these guidelines are applied by medical schools; decisions are either supported or denied by each school based on whether it is felt that curriculum requirements are either fully or partially satisfied (Wicclair, 2010). The National League for Nursing Accrediting Commission (NLNAC) which accredits all nursing education programs does not prescribe guidelines about CBEs. The decision of whether or not to have policies or guidelines about CBEs is up to each individual nursing program (Personal Communication with S. Tanner, executive director, National League for Nursing Accrediting Commission, Atlanta Georgia, February 3, 2010). According to the Accreditation Council for Pharmacy Education, which serves as the sole accrediting body for all colleges and schools of pharmacy in the US, all pharmacy students, including those at faith-based institutions, must be exposed to the entire range of therapies, products, and the like, including those that might tread into areas of CO (Personal Communication with L. Antikainen, Accreditation Facilitator, Accreditation Council for Pharmacy Education, Chicago, Illinois, February 9, 2010). According to the Council on Social Work Education (CSWE), objections of conscience by students are beyond the purview of CSWE s Educational Policy and Accreditation Standards (EPAS). The Commission on Accreditation considers decisions related to CO internal and up to each individual social work program (Personal

4 40 Teaching Ethics, Fall 2012 Communication with J. Bremner, Director, Office of Social Work Accreditation and Educational Excellence, Washington, DC, February, 24, 2010). Professional Values & Ethical Behavior in Social Work Commentators suggest that social work is among a small elite group of value based professions (Mattison, 2000; Noble & King, 1981; Osmo & Landau, 2003), which highlights principles such as, social justice, respect for diversity, anti-oppressive practice, and social change; and responsibilities to clients, such as, confidentiality, accountability, respect of individual differences, being non-judgmental, and tolerance. Commentators explain that social workers cling religiously to their values; we seem to cling to them intuitively, out of faith, as a symbol of our humanitarianism (Vigilante, 1974, p. 114). Some go as far as to suggest that social workers are merchants of social morality (Pilseker, 1978). The profession s deep value-based roots serve as the foundation of the profession s mission, the relationships social workers have with clients and society, methods of interventions used, and for resolving ethical dilemmas (Reamer, 2006). Although the teaching of professional ethics is a distinctive feature of most health-based professions curricula, schools of social work place a particular emphasis, (perhaps more than other disciplines) on educating students about social work values, and the standards and types of actions that constitute ethical behavior. CSWE mandates that every MSW and BSW program infuse values and ethics throughout the curriculum (Council on Social Work Education, 2001). The NASW Code of Ethics, which in addition to providing guidelines and responsibilities for ethical conduct, provides a set of core values which serve as the foundation for the work that social workers do, especially with regard to sensitivity and respect of clients. Social workers should have a knowledge base of their clients cultures and be able to demonstrate competence in the provision of services that are sensitive to clients culture and to difference among people and cultural groups (Standard 1.05b). Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, sex, sexual orientation, age, marital status, political belief, religion and mental or physical development. (Standard 1.05c).

5 J. Sweifach: Conscientious Refusal in Schools of Social Work: Rights, Remedies, and Social workers are expected to act to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, or mental or physical disability (Standard 6.04). The social worker s primary responsibility is to promote the well-being of clients (Standard 1.01). One theme which runs throughout the Code of Ethics, and CSWE s accreditation standards is the significance of inclusion, and the importance of preparing social workers to effectively work with all populations. For example, commentators explain that schools of social work are obligated to ensure that social work students are prepared to work with individuals of different genders, social classes, religions, ages, LGBTQ individuals, and physical and mental abilities (Child Welfare League of America & Lambda Legal, 2006; NASW, 2007). Commentators suggest that clashes between personal and professional values are inevitable (Reamer, 2006). The conflict emanates from the clash between two or more values, each of which can be substantiated as morally correct and ethically grounded (Linzer, 1999; Mattison, 2000; Rokeach, 1973). Although social workers are admonished to limit the influence of personal values on professional practice, commentators suggest that for some social workers, especially those for whom their personal worldview is fundamentally religious or informed by a particular moral order, putting aside values regarded as immutable, is difficult (Linzer, 1995; Spano & Koenig, 2008). This challenge may be especially difficult for students, many of whom perhaps, have had only limited exposure to social work values, and now must learn, internalize, and accept simultaneously. The process of incorporating social work values into one s professional self-concept may be fraught with conflict and resistance; especially for students maintaining deeply held moral/religious commitments. For some students, the conflict may prove to be too difficult, and necessitate the consideration of alternatives. One option, which does exist within professional settings, involves opting-out of that which is found to be morally/religiously objectionable. The question of whether this option ought to be considered within the educational realm remains.

6 42 Teaching Ethics, Fall 2012 METHODOLOGY Design and Subjects Drawing from the accumulating literature on CO in professions such as medicine, pharmacy, and nursing (e.g., Anderson, Bishop, Darragh, Gray, Nolen, & Poland, 2006; Curlin, Lawrence, Chin, & Lantos, 2007; Wernow, 2008; Wilson, 2008), a survey instrument was constructed to examine perceptions and opinions of respondents about social work students who wish to opt-out of participating in school activities found to be objectionable. Exempt status was received for conducting the research through the Albert Einstein School of Medicine s internal review board. The survey was developed using Survey Monkey, a web-based platform for conducting surveys. All responses were anonymous, and no method of tracking individual identity was utilized; respondents IP addresses were encrypted to protect personal information. Given that these survey data were completely anonymous, and no identifying information was collected, informed consent was waived. A database of social work administrators was created using staff directories from social work agency websites. Administrators were asked to forward a cover letter, soliciting participation, and a survey link to personnel at their agency. The cover letter invited respondents to forward the survey link to colleagues. This is a mechanism similar to convenience and snowball sampling (Babbie, 2001) or word-of-mouth communication, termed in the literature as the pass-along approach (Norman & Russell, 2006). In addition, a survey link was posted on an array of social work-based webpages (e.g., NASW, facebook, social work blogs), inviting users to participate in the survey. Prior to conducting the study, a draft survey was sent to a pilot group of social workers to evaluate the face and content validity of the instrument. The social workers were alumni at the University where the researchers work. Respondents taking the pilot test did not remain eligible to participate in the actual study. Suggested changes were incorporated into the final version of the survey. Of the 3,300 surveys sent, 2,650 surveys were successfully delivered electronically; 650 bounced back as undeliverable. Of the successful transmissions, 923 of those surveyed returned completed useable questionnaires for an overall 35% response rate.

7 J. Sweifach: Conscientious Refusal in Schools of Social Work: Rights, Remedies, and Instrument The first section of the questionnaire sought to understand the extent to which respondents perceive that social workers have a right to remove themselves from situations which conflict with personal religious or moral beliefs. The second section of the questionnaire queried respondents about their perception of students who opt-out. The third section of the questionnaire asked respondents to identify their views on an array of contemporary ethical issues such as stem cell research, first trimester abortion, gender re-assignment surgery, contraception, etc. The fourth section of the survey asked respondents about their own personal religious practices, as well as their ideological and political views. The final section focused on general socio-demographic areas. Each section included numerous open-ended questions. Data Analysis The study employed a mixed model design with a qualitative emphasis allowing for thematic as well as quantitative data analysis. The quantitative portion of the data analysis was conducted using SPSS version Means, standard deviations, frequencies, and percentages were used to generate descriptive results. A significance level of.05 was used for all inferential statistics. The main part of the survey was qualitative in nature, focusing on open-ended questions. These comments were evaluated separately in order to identify patterns and other indicators that might shed light on how respondents view CO within social work education. Grounded theory guided the analysis of open ended comments (Dick, 2005). All comments were read, and a list of initial codes was developed based on content and meaning. Comments were then reread focusing on developing theoretical constructs and logical groupings of themes. Measures Several indices were constructed from survey items. Each index was dichotomized at the mean. Each index was comprised of items with five ordinal categories, all logically compatible. For each scale, items were recoded in order to maintain consistency in direction and clarity of interpretation with the other scales. The scores were obtained by calculating the mean. Responses were dichotomized as high or low based on original rating scales, i.e., high to low corresponding with important to unimportant, agree to disagree, often to rarely. A Cronbach s alpha was conducted to assess the reliability of the indices.

8 44 Teaching Ethics, Fall 2012 Cronbach s alphas, were all above.70. In addition to the list of survey items, 345 respondents (40%) wrote comments pertaining to CO in schools of social work. Questions related to respondent impressions about social work students who object to course content and who request to be excused or exempted from learning content which conflicts with the student s worldview. Demographics Of the respondents who indicated their gender, 75.7% were female, 23.6% were male, and.7% indicated other. This ratio is consistent with other data on the human services labor force which reflects a growing trend of feminization (Bureau of Labor Statistics, 2003; Gibelman & Schervish, 1997). The mean age of the sample was 48 years old. The mean annual family income was approximately $75, The vast majority of respondents self-identified as White (84%), 5% African-American, 3.5% Latino, and 7.5% other. In regard to marital status, 67.5% of respondents indicated they were married or living with a partner, 2.6% were widowed, 10.8% were divorced or separated, 19.1% were single. With regard to sexual orientation, 83% indicated that they are heterosexual; 11.4% indicated gay/lesbian, 3.8% indicated bisexual; 0.4% indicated that they are questioning/unsure. Thus the sample was primarily white, near 50 years old, middle class, heterosexual and female. Of the respondents who answered the question about religion, 42.5% indicated that they were Christian; 24.7% indicated Jewish; 19% indicated Agnostic or no religion. Other religions were all under 1.5% or less. In regard to highest degree obtained, 3.5% hold the BSW as their highest degree, 81.9% the MSW, 11.9% a PhD or DSW, and 2.7% other. Respondents provided their state of residence; table 1 shows their geographic distribution. Table 1. Geographic Distribution of Respondents (n=788) Re-Coded Region Sample Representation Region I and II = Northeast 40% (n=324) Region III and IV = South 18% (n=142) Region V and VI = Mid and Southwest 18% (n=146) Region VII and VIII = Central and North 6% (n=44) Central Region IX and X = West 17% (n=132)

9 J. Sweifach: Conscientious Refusal in Schools of Social Work: Rights, Remedies, and Professional Characteristics Respondents are an experienced group of social workers. The vast majority (69.1%) reported having ten or more years of work experience in the social work profession. Only 6.3% reported having 0-5 years of experience. A primary function of direct service was indicated by 35.6% of respondents. An additional 18.2% of respondents indicated that their primary function is in private practice, the majority of whom provide direct service. Only 7.6% of respondents reported working in executive (senior) management and another 15.1% reported their primary function to be middle management. Such findings mirror those of other labor force studies of social workers (see, for example, Gibelman & Schervish, 1997). The majority of respondents work full-time (75.3%), 18.9% work part time, 5.8% indicated that they are unemployed/retired. Religious, Moral, and Socio-Political Views According to the moral views scale the respondents of this study do not tend to object to contemporary moral issues such as abortion, stem-cell research, euthanasia, and same-sex marriage. The religiosity scale suggests that respondents fall along a wide continuum of religiousness. According to the socio-political scale, respondents lean more toward liberal political and social views than conservative (see table 2). Table 2. Moral views, religiosity, and socio-political scales Description of scale Moral Views Scale Religiosity Scale Social Political Scale Moral or religious objections to controversial issues (e.g., same sex marriage, abortion, etc.). Religious Practices (e.g., religious service attendance, adherence to religious laws, and rituals, etc.). Social and Political Views (e.g. how would you describe your political views, your views on social issues; your views on economic issues). # of items n α Mean (SD) Potential Score Range (.57) 1 to 3 Interpretation of scale LOW HIGH Less moral or religious objection (.63) 1 to 3 Less religiosity (.52) 1 to 3 More Liberal Views Greater moral or religious objection Greater religiosity More Conservative Views

10 46 Teaching Ethics, Fall 2012 Students Who Opt Out A substantial proportion of the sample expressed strong views regarding opting-out of course content in schools of social work (see table 3). Table 3. Views about students who opt out (strongly disagree or disagree) % n Social work students who claim conscience objection, ought to be excused from classes when the material being presented conflicts with their moral/religious beliefs Social work students should be exempt from answering questions on licensing or other exams which conflict with their moral/religious beliefs Social work students who walk out of class when they have a moral/religious objection to the material being presented should not be given a consequence. 92% % % 585 Respondents were also provided with an opportunity to make comments throughout the survey. Comments were numerous, noted by 345 respondents (40%). Comments were grouped into the following categories: 1) knowledge/skill deficits (a gap in educational content could result in knowledge and skill gaps); 2) opting-out is unacceptable (students do not have the right to opt-out; 3) student autonomy (students have a right to be excused when they object to the material being taught); 4) wrong profession: (students do not have the right to opt-out, and should consider another profession); 5) social work is deeply value based; more than other professions, social work values are the fulcrum of practice (Vigilante, 1974). Respondents also recommended solutions; these categories/comments follow. Knowledge/Skill Gap Concerns About 18 percent of respondents who wrote comments expressed concern that students who opt-out are at risk of not acquiring the knowledge, skills, and attitudes needed to become competent professionals. Comments included the following: It s important to at least learn about other choices, options, issues, ideas, and lifestyles. To walk out of class and not expose oneself to a broad spectrum can lead to parochialism and intolerance. All social workers must be completely educated. The student who is intolerant to certain subjects will likely miss educational content that would inform his/her practice. A social worker with incomplete education should not be allowed to get a degree and practice. I think if a student, whether medical, legal, or mental health, is preparing for a profession,

11 J. Sweifach: Conscientious Refusal in Schools of Social Work: Rights, Remedies, and he/she should be responsible for learning about the topics that inform her practice. Learning does not mean to go against one s beliefs. I would want to know if my social worker had a paucity of knowledge. I would find another social worker. This is the time to determine whether one s beliefs are too strong to help others make decisions based on their beliefs. A student must not be exempt from addressing all the issues pertinent to our work. If a student cannot discuss difficult topics even in the classroom setting, how will they address them in complex and emotionally charged practice situations? We cover these topics in class because we see them every day in practice. Twenty five percent of respondents felt that students do not have a right to opt-out. Opting-out is not acceptable. To me, it violates the principle of do no harm. It is harmful to have an ignorant social worker. Opting-out is wrong. The primary professional consideration should be benefits and risks to clients, not the ideations of individual social workers, especially when they may be placing clients at risk. Trained and licensed people do not have the right to ignore information, just because it offends their beliefs. It s real and it exists. Students may disagree with the material, but they are students and must not be allowed to walk out. Life does not present the opportunity to opt-out, and neither should school. A small minority of respondents (3.8%) felt that students do have a right to opt-out. Sometimes professors are a bit in your face with their interpretation of the Code. Students should be allowed to walk out without fear of repercussions. I believe students have a right to walk out, but they should be held accountable on exams for responding to questions, as long as the question does not force the student to make a false statement. Students should be able to say no without fear of repercussions. We speak endlessly about rights, and at times as individuals, we need to stand up for something. Like draft conscientious objectors, alternatives should be given. Almost 1/3 of respondents (29%) felt that students who opt-out ought to consider another profession.

12 48 Teaching Ethics, Fall 2012 The rejection of discussion is where a student might need to be cut loose; there is no place in this profession for people like that. A social worker who is uninformed about substance abuse or sexually transmitted disease is a social worker who cannot fulfill his professional obligations due to willful ignorance. I would not hire such an ill informed worker. Part of social work is being broad minded and open to working with all people who come in various shapes and sizes, with differing belief systems. If one is not prepared to do this, find another profession. A social worker with values extremely at odds with those of the social work profession is an oxymoron. If such people want to practice social work, perhaps they should invent a new term religious social work or something and set up standards, training institutions, and so forth. As a social work student, if you find yourself feeling morally or religiously against working with diverse populations in particular, clients who are vastly different than you or those close to you, you need to consider a different major. Social work degrees should be highly regarded, and available to only those who can embrace difference. It s not about you, it s about your clients. Almost 1/3 of respondents expressed that social work is a deeply value based profession, suggesting that opting-out in schools of social work should be treated differently than opting-out in other educational settings. Social workers must be held to a higher standard than other professions. We have an obligation to become both critical thinkers and ethical analysts in order to advocate for clients, and make needed changes to social policy. This is the history of the profession, and it is often lost. Social work is such a great profession because it is a value free profession. To let some opt-out due to religious beliefs makes it a profession with judgments, and social workers do not judge. We are not a see no evil, hear no evil profession. We have an obligation to understand all differences among people and let go of the this is wrong attitude/belief. There is no place for that in this work (I say this being a strong religious and spiritual person. We are not lawyers or medical students, and we shouldn t have the same choices they do. The social work profession is founded on advocating for those who are disenfranchised. We

13 J. Sweifach: Conscientious Refusal in Schools of Social Work: Rights, Remedies, and shouldn t be part of the disenfranchising problem. The social work Code of Ethics is in a different category than other codes. Our Code expects that we will stand up and support the values of this profession. Some respondents proposed strategies for responding to students who request a CBE. Opting-out should be consequenced with an assignment that addresses the need for the absence and a proposal for attending to the objectionable material this to raise consciousness at the very least. Personal choice to leave should be further evaluated with an advisor to understand one s academic and career motives. Students should be encouraged to remain in class to broaden their perspective. Students should be respectfully listened to, their position acknowledged, and they should be required to learn the material. Students who object should be required to attend diversity training which emphasize social justice, equality, and the connection between oppression and discrimination. Students ought to be informed at the outset of the school s requirements (e.g., issues that may be presented in class with which one does not agree) but the expectation is that one remains in class. LIMITATIONS There are a few limitations in this study that must be discussed. A modified convenience sampling method was used to collect the data. It is possible that this method led to a self-selection bias, that is, the study may have attracted only those social workers who have an interest in objections of conscience. Furthermore, reliability of self-reported attitudes are subjected to the participants inclination to promote a favorable opinion of the social work profession. Finally, the use of a web-based online survey might result in obtaining a biased sample, as it unintentionally excludes potential participants who lack access to or comfort with the Internet. DISCUSSION The large majority of this study s respondents felt that social work students should not have the option of opting-out of course content. A

14 50 Teaching Ethics, Fall 2012 significant proportion of respondents go further, expressing that students who wish to opt-out ought to be counseled out of the profession. The respondents of this study also expressed that social work has a unique relationship to values, more than other professions; suggesting that opting-out in medical school may be acceptable, but this option should not extend to social work students. Commentators suggest that social work is one of the most value based professions (Osmo & Landau, 2003). The respondents of this study agree; when asked to rank social work on a scale from 1 to 10 (high) with regard to how value-based they feel the profession is compared with other professions, 75% ranked social work 7 or higher. Perhaps these strong opinions regarding opting-out may result, in part, from an identification with social work s strong value base? Social workers pledge a commitment to diversity, tolerance and inclusion (Hodge, 2007); accepting these values as part of a professional oath. Respondents of this study appear to feel that one s professional oath overrides worldview or religious allegiances. IMPLICATIONS In recent years, the media has focused a great deal of attention on professional acts of CO. Most recently, controversy surrounding a pharmacist s right to refuse to fill a prescription has made headlines. The issue has also been the subject of contentious debate at the highest levels of government. Just prior to leaving office, the Bush administration enacted laws which reinforce protections for health care providers who object to providing services based on their personal beliefs. After taking office, the Obama administration began a process to rescind the Bush policy (Stein, 2009). It appears reasonable to conclude that increases in the prevalence of CO at the educational level could very well parallel occurrences within the professional realm. Education however, is different from practice. For example, health profession associations (pharmacy, nursing, medicine) have created exemptions for professionals to opt-out of practice situations which conflict with religious or moral worldviews; whereas university accrediting bodies for health profession education (other than medicine), do not appear to support this same option for students. CO by students within universities both at the graduate and undergraduate level does take place (Franck, 2004; Goodison, 2008; Suchetka, 2002; Wicclair, 2010). Respondents of this study expressed that

15 J. Sweifach: Conscientious Refusal in Schools of Social Work: Rights, Remedies, and CO does take place in schools of social work as well. One respondent stated: I am an adjunct professor, and on more than one occasion, students have walked out during discussions about working with gay clients. Another stated: My friend walked out during the movie If these walls could talk 2 that upset me. One respondent stated that a classmate stood up during a discussion about HIV/AIDS, and announced that the discussion was too sexually explicit, and was against her religion to deal with such subjects; she then left. To augment findings, faculty members at the researcher s school were contacted by asking whether they have experienced students walking out of class as a result of conflicts with a religious/moral worldview. About 20% (n = 8) stated that this has occurred in their classes. The extent to which this is true at other schools is an area ripe for future research. Respondents identified that classroom content for which optingout might be sought include topics related to sexuality, substance abuse, birth control, sexual orientation, gender identity, abortion, and STDs. These topics however, are fertile ground for discussion in most social work classes, and are consistent with CSWE s education policy. Course curricula in all CSWE accredited schools, are subject to review by each school s curriculum committee, and as part of the CSWE accreditation process, curriculum content is reviewed and evaluated to ensure that it complies with accreditation standards. Given the rigorous examination and oversight that school curricula receive, it would appear reasonable for both CSWE and schools of social work to expect that students ought not be exempt from this content. Commentators explain that allowing students to dictate course content ignores sound pedagogical methods, and may hamper learning (Brookfield, 1995; Delucchi & Smith, 1997; Edmundson, 1997). Moreover, in schools of social work, the course content perceived as most contentious is very likely that which is most critical, as it relates directly to marginalized populations. As well, these areas of practice are particularly emphasized as critical to the learning process by CSWE and the Code of Ethics. It seems conceivable that if content is not learned, it will not be practiced, and if values are not embraced, they will be discarded. The Code, although written in general terms to maximize application, contains specific standards with implied meanings, reflecting the value base of the profession. Indiscriminant application of the Code or arbitrary discard of standards can potentially cause wide variations in practice, and lead to inconsistencies in how the profession is understood and viewed by the public; and ultimately how services are delivered and received.

16 52 Teaching Ethics, Fall 2012 REFERENCES Anderson, R., Bishop L., Darragh, M., Gray, H., Nolen, A., & Poland, S. (2006). Pharmacists and conscientious objection. Kennedy Institute for Ethics, 16(4), Babbie, E. (2001). The practice of social research. Belmont, CA: Wadsworth. Brookfield, S. (1995). Becoming a critically reflective teacher. San Francisco, CA: Jossey-Bass. Child Welfare League of America & Lambda Legal (2006). Getting down to basics: Teaching LGBTQ competence in schools of social work. Washington, DC and New York, NY: ACWLA/Lambda Legal Joint Initiative. Council on Social Work Education (2001). Educational policy and accreditation standards. Alexandria, VA: CSWE. Curlin, F. A., Lawrence, R. E., Chin, M. H., Lantos, J. D. (2007). Religion, conscience, and controversial clinical practices. New England Journal of Medicine, 356(6), DelFattore, J. ( 2004). The fourth R: Conflicts over religion in America s public schools. New Haven: Yale University Press. Delucchi, M., & Smith, W. (1997). Satisfied customers versus pedagogic responsibility: Further thoughts on student consumerism. Teaching Sociology, 25(4), Dick, B. (2005). Grounded theory: A thumbnail sketch. Resource Papers in Action Research. Retrieved March 16, 2010 from Edmundson, M. (1997). On the uses of a liberal education: As lite entertainment for bored college students. Harpers, 295(1768), Franck, M. (2004, March 18). Bill to let Missouri pharmacists refuse to fill morning-after prescriptions. Knight Ridder Tribune Business News, p. 1. Gibelman, M., & Schervish, P. (1997). Who we are: A second look. Washington, DC: NASW Press. Goodison, D. (2008, January 10). Failed bar exam-taker apologizes to gays. Boston Herald, p. 28. Hodge, D. (2007). Progressing toward inclusion? Exploring the state of religiousdiversity. Social Work Research, 31(1), Linzer, N. (1995). Ethical dilemmas in Jewish communal service. Hoboken, NJ: KTAV. Linzer, N. (1999). Resolving ethical dilemmas in social work practice. Boston: Allyn & Bacon. Mattison, M. (2000). Ethical decision making: The person in the process. Social Work, 45(3),

17 J. Sweifach: Conscientious Refusal in Schools of Social Work: Rights, Remedies, and Noble, D., & King, J. (1981). Values: Passing on the torch without burning the runner. Social Casework, 62(10), Norman, A., & Russell, C. (2006). The pass-along effect: Investigating word-of-mouth effects on online survey procedures. Journal of Computer-Mediated Communication, 11(4), Osmo, R., & Landau, R. (2003). Religious and secular belief systems in social work: A survey of Israeli social worker professionals. Families in Society, 84(3), Peverly, P. (2007). Draw the line or cross it? Pulse, 67(37), 29. Pilseker, C. (1978). Values: A problem for everyone. Social Work, 23(1), Reamer, F. (2006). Ethical standards in social work: A review of the NASW code of ethics (2nd ed.). Washington, DC: NASW Press. Rokeach, M. ( 1973). The nature of human values. New York: Free Press. Spano, R., & Koenig, T. (2007). What is sacred when personal and professional values collide? Journal of Social Work Values and Ethics, 4(3), Retrieved from view/69/54/ Stein, R. (2009, February 28). Health workers conscience rule set to be voided (Washington Post, p.a01. Suchetka, D. (2002, July 23). University sued for Islamic reading requirement. Knight Ridder Tribune News Service. p. 1. U.S. Department of Labor, Bureau of Labor Statistics. (2003). Tabulations from the current population survey, 2002 annual averages. Washington, DC: Author. Vigilante, J. (1974). Between values and science: Education for the profession during a moral crisis or is proof truth. Journal of Education for Social Work, 10(3), Wernow, J. (2008). Dispensing with conscience: A history of difference. Ethics & Medicine, 24(2), Wilson, R. (2008). Matters of conscience: Lessons for same-sex marriage from the healthcare context. In Douglas Laycock, Anthony Picarello, and Robin Fretwell Wilson (Eds.), Same sex marriage and religious liberty: Emerging conflicts. Lanham, MD: Rowman & Littlefield Publishers, Inc. Wicclair, M. (2010). Conscience-based exemptions for medical students. Cambridge Quarterly of Healthcare Ethics, 19(1), Witham, L. (2002, June 26). If it says God, so be it. Washington Times, p. A01.

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