Ethical dilemmas: What would you do?
Learning Objectives
After considering this resource, you should be aware of the potential when dealing with difficult situations and how to make sound ethical decisions in the best interest of the service user.
Good social work practice depends on maintaining high ethical standards, even in the most demanding and complicated of situations. Many of these standards are set out in codes of practice and organisational policies and some generally understood best practice. You should research your employer's policies, procedures and codes of conduct as well as those of relevant professional bodies. Inevitably though, you may be confronted by complex situations where the right thing to do isn’t always clear.
In this activity, Jennifer Burton – author of Practice Learning in Social Work - presents three different scenarios. Consider each one and respond accordingly to the question at the end of each case study. You might wish to discuss your views with other students or your practice educator or lecturer and to listen to other arguments. When you select an answer, feedback will be provided that will reflect the issues at hand.
This activity presents four different scenarios. Consider each one and respond accordingly to the question at the end of each case study. There is no wrong or right answer as different circumstances will change how you deal with situations. You might wish to discuss your views with other students or your practice educator or lecturer and to listen to other arguments. When you select an answer, feedback will be provided that will reflect the issues at hand.
Scenario 1
A young man with cerebral palsy and sight impairment is assessed for a direct payment and is visited by a social worker to agree on a support plan for the funding. The service user decides that he would like to spend the money on a holiday abroad, rather than using the local respite services as the cost will be the same. The social worker advises that he does not travel abroad due to the risks this would entail due to his disabilities.
Do you agree with the social worker’s advice?
The social worker is taking a ‘safety first’ risk assessment position in suggesting that the direct payments should be used for traditional respite services that are already quality assured and familiar to the service user. The medical model of care seems to be the preferred option here, as the social worker is considering the individual’s disabilities in a biological way rather than taking a social model of disability approach which seeks to identify and remove the barriers that can be created by society and can disadvantage minority groups such as disabled people.
However, it may be that in considering the wisest choices the social worker is actually being judgemental and is therefore not fully respecting the service user’s personal wishes and aspirations for taking control of his own life. The Professional Capability ‘Diversity’ requires that social workers appreciate that service users can be marginalised and oppressed if their differences and diversity are not respected by enabling personal life style choices to be made.
There is a subtle but important difference between making a professional judgement and being judgemental; the social worker is not tuning in to the service user’s needs, wants and aspirations when responding to the choices he has made. The process of risk taking is part of day-to-day life and should be person centred and based on minimising rather than removing any risks. Thompson’s ‘ Growth Zone’ model is very relevant here, as individuals may need social work support to move from a ‘comfort zone’ in their life where change may be seen as threatening, towards the ‘growth zone’ where confidence is encouraged. The growth zone in this scenario would be encouraging the service user to try new experiences whilst ensuring that support was in place to avoid the individual from moving into the ‘danger zone’ by being exposed to high levels of risk.
Rather than the social worker imposing their own values and beliefs on the service user’s aspirations it is important to ensure that the person feels in control and is able to weigh up the risks attached to having a respite break abroad as part of the planning and decision making process. The social worker may well feel protective towards the service user in a genuine and caring way although the ethical challenges of effective partnership working with service users sets out an obligation for social workers to recognise diversity, rights, justice and economic wellbeing and to work with the service user to maximise independence, dignity and choice.
Scenario 2
An initial home visit is carried out by a social worker to an older couple because the husband has dementia which is becoming difficult for his wife to manage at home. The wife becomes very tearful and discloses that her husband has lashed out and hit her, causing her to fall and sustain bruising. The social worker agrees to keep this information to herself when the woman becomes anxious and asks her not to tell anyone.
What would you have done? Was the social worker right to do this?
Trust between the carer and the social worker may be broken if confidentiality is not maintained and the disclosure is shared with other professionals. However, The Health and Care Professions Council (HCPC) Guidance on Conduct and Ethics refers to the importance of respecting the confidentiality of the service user yet also to always act in the best interests of the service user. This ethical dilemma of keeping something confidential which conflicts with the duty of care to prevent harm needs to be considered very carefully, as not sharing an important disclosure may not be in the service user or carer’s best interests.
The social worker will be aware of the fear that can be invoked when carers are faced with the possibility of a loved one being placed in residential care due to the increased support required. The social worker may be respecting the choice that the carer has made in order to keep her husband at home; however the need to protect people who may be vulnerable and exposed to high risk needs to be of paramount importance.
The social worker is breaching the professional code of upholding adult safeguarding principles by respecting the carer’s disclosure as confidential when physical abuse is likely to have taken place. Although the social worker may find it uncomfortable to explain to the carer that this information will need to be shared due to the risk to her own safety and to her husband’s health if this does not happen, the social worker is being collusive in her actions and is not being open and transparent about the risks if this information is not passed on to key professionals and agencies.
Implicit within the Professional Capability ‘Professionalism’ is the need for social workers to take responsibility for their own conduct as representatives for the profession. This can mean using professional judgement to make difficult but necessary decisions. The social worker in this case will need to use skills of empathy balanced with taking preventative action to ensure safety whilst also balancing risks and rights. The social worker will be able to advocate on behalf of the carer for example, to recommend that additional support is available to maintain her husband at home which will minimise the risks identified. The carer is also entitled to an independent assessment to recognise her own support needs, which may include some respite and additional practice help in the home.
Scenario 3
A social worker has supported a young mother and her two children for several months to move from an abusive relationship to a refuge and then on to a home of her own. When the case is closed the social worker promises to keep in touch and to ‘always be there for her’.
Do you agree with the social worker’s approach?
Professional boundaries between the social worker and the service user can create tensions, particularly when a strong bond may have been established between the social worker and the service user. In circumstance such as this one the social worker will have intervened to facilitate positive change during a time of chaos, which may form a connectedness that oversteps formal boundaries. If the social worker commits to the young mother this will strengthen the person centred working relationship, as the social worker will want to ensure that trust and unconditional positive regard are conveyed to the young mother and her children during a time of uncertainty and unrest.
The service user may feel let down if the social worker, as a valued point of contact, is withdrawn and the power balance between the professional social worker and the service user may appear to be compromised if the working relationship is ended. However, despite the commitment that the social worker has shown to the mother at a time of great need it is essential that the distinction between ‘friend’ and ‘professional’ is recognised and the professional relationship is seen to have a clear beginning and end. The Professional Capability ‘Intervention and Skills’ refers to the importance of the social worker using professional judgement and authority to intervene in order to promote independence and provide support to prevent harm, neglect and abuse. It is important for the social worker to recognise when this intervention has come to a close and other professionals or agencies become involved if necessary.
The social worker will need to reflect carefully on her professional role and the remit of the working relationship with the young woman and her family. This requires a professional distance, whilst still working for the best interests of the service user. Will it be in the service user’s best interests to maintain a relationship with a social worker who is no longer actively involved and could this affect the service user’s resilience in being able to move forward and establish a new start with her children?
The Professional Capability ‘Values and Ethics’ requires social workers to make ethical decisions and work with service users in a way that demonstrates professional use of self. This skill set requires the social worker to be able to retain professional boundaries and empower rather than ‘rescue’ people. Skilful intervention requires professional boundaries to be in place and the ability to shift the power towards the service user to ensure that dependency is not created, but rather that we empower individuals to take control of their own lives. On a practical note, taking account of limited resources and time constraints, how realistic is it for the social worker to make a promise to ‘always be there? It could be argued to be setting up false hopes and expectations that just can’t be sustained.
- What are the issues you considered when responding to each of these scenarios?
- How do you respond when a service user expresses a desire that is at odds with your professional opinion?
- Did your opinion change having read the feedback to the answer you gave?
- Discuss these scenarios with your colleagues. Are you surprised by their responses?