Source: CMSA Today
BY RAINE ARNDT-COUCH, DSW, JD, LCSW, CCM
The Ethical Foundations of Case Management
Professional case managers are expected to behave and practice ethically, adhering to the tenets of their respective professional codes of ethics. Additionally, the CMSA Standards of Practice for Case Management (“Standards of Practice”) Standard D – Ethics includes five foundational principles that case managers are expected to apply to all actions taken in their professional capacity.
These principles are:
- Autonomy – To respect individuals’ rights to make their own decisions.
- Beneficence – To do good.
- Fidelity – To follow-through and to keep promises.
- Justice – To treat others fairly.
- Nonmaleficence – To do no harm.
These principles support the formation and sustainment of a professional moral compass, guiding the case manager’s actions in both routine and extraordinary circumstances.
Ethical Dilemmas in a Shifting Political Climate
Increasing political polarization and significant proposed and actual changes in public and health policy have intensified the ethical pressures placed on healthcare professionals, including professional case managers.
Consider the following scenarios:
– A state passes legislation restricting access to gender-affirming care. A case manager must support a transgender patient in identifying safe, affirming providers, all while adhering to the new law and organizational policy.
– A federal rollback on certain health coverage benefits forces difficult conversations with patients facing rising out-of-pocket costs and fewer options.
– Immigration enforcement increases, discouraging undocumented patients from seeking care. The case manager is torn between potential reporting requirements and the ethical imperative to protect vulnerable individuals.
These examples underscore the need for ethical vigilance and professional courage. The CMSA Standards of Practice call on case managers to recognize when laws, rules, or policies conflict with ethical practice—and to seek resolution or consultation when necessary.
Putting Principles into Practice
Professional ethics are not abstract ideals; they manifest in everyday decisions.
Consider how the following principles are applied:
– Autonomy: A case manager advocates for a cognitively capable patient’s right to decline a high-risk surgery, despite pushback from family or providers.
– Justice: Ensuring a low-income patient with limited English proficiency receives the same quality of care and follow-up as a privately insured patient.
– Fidelity: Following through on care coordination promises even when organizational resources are constrained.
In addition, identifying and acknowledging the impact of personal biases on one’s practice is essential. So too is understanding the myriad factors that may impact an individual’s access to equitable care including race, income, disability, and migration background and taking steps to mitigate these impacts through application of ethical decision making.
The Case Manager as Ethical Leader and Advocate
Case managers are uniquely positioned to promote ethical conduct within interprofessional teams and healthcare organizations. This role includes:
– Advocating for policy changes that reduce disparities.
– Encouraging inclusive, trauma-informed care models.
– Educating peers and patients on rights, risks, and alternatives.
– Participating in ethics committees or seeking legal counsel in complex cases.
Moreover, ethical leadership includes self-care. Moral distress—the internal conflict that arises when one cannot act in accordance with their values—can affect job satisfaction and mental health. Engaging in supervision, peer support, and ongoing ethics training are proactive actions case managers can take to reduce this risk.
Charting a Way Forward
The CMSA Standards of Practice provide more than just guidelines—they help to articulate the professional identity of case managers. In the face of evolving legal requirements and systemic inequities, ethics remain an unwavering pillar of case management.
By returning to core principles, professionals case managers can navigate even the most politically fraught situations with clarity and compassion. Ethics cannot be viewed as simply a section in the CMSA Standards of Practice that lies dormant on a bookshelf —we must use ethics to guide everyday practice, now more than ever.
References
Case Management Society of America. (2022). Standards of practice for case management (5th ed.). https://www.cmsa.org/wp-content/uploads/2022/05/CMSA-2022-Standards.pdf
Dr. Raine Arndt-Couch, DSW, JD, LCSW, CCM, FCM, serves as Blue Shield of California’s director of social services management, Medi-Cal population health management, and is a current member of the CMSA Today Editorial Board. Raine has extensive clinical social work, case management, health care policy, and leadership experience in various health care settings and served as CMSA National Board of Directors Member-At-Large from 2022-2025. She earned both her Master’s in Social Work (MSW) and Juris Doctorate (JD) from the University of Hawai‘i at Manoa and her Doctorate in Social Work (DSW) from the University of Southern California.
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