Ethical Issues and the Social Worker, Essay Example

Ethical issues, dilemmas and the social worker in a health care environment

When working in a health care environment, such as a hospital, clinic, a nursing home, or especially a hospice, ethical issues or dilemmas for the social worker are bound to occur. The conditions under which these dilemmas tend to arise varies greatly, but overall, they are dependent on the client and the illness and/or disease that the patient is suffering from, and how far the worker is willing to go to help the client concerning moral beliefs and principles.

Also, the types of ethical issues or dilemmas are often different for the social worker as compared to a professional nurse, due to the social worker not being involved in patient treatment or care, at least under most circumstances. But nonetheless, the social worker is often forced to confront various types of ethical dilemmas that will test his/her professional skills and talents and perhaps force the social worker to make decisions based on life and death.

According to N. Beckerman, ethical issues for the social worker are more often than not ethical dilemmas or situations that require difficult decisions to be made. By definition, an ethical dilemma is a situation in which “an action is required that reflects only one or two values or principles that are in opposition to one another” (1996, p. 6).

Many times, these ethical issues or dilemmas involve the principles of autonomy or the right of the patient/client to self-determination, and beneficence or the worker’s responsibility to behave and act with the client’s best interest in mind.

Beckerman refers to this as a clash between the right of a client to determine his/her own fate and the social worker’s need to do what is right and proper for the client (1996, p. 6). Of course, all social workers are expected to adhere to the professional standards of the National Association of Social Workers (NASW). These standards or rules based on ethical behavior were designed to help “improve practice and service delivery” but are only effective if the social worker adopts them as his/her own guiding principles (Standards and Ethics, p. 57).

One of the most common ethical issues or dilemmas that a social work might have to contend with is related to a conflict of interest. With this scenario, the social worker might have to play a balancing game between the client/patient and his/her loved ones. For example, the wishes of the client may conflict with those of a spouse, particularly if the client/patient is elderly and is suffering from some kind of mental impairment, such as with Alzheimer’s disease; the wishes of children may conflict with the wishes of the client/patient; a difference in interests related to a legal guardian vs. the interests of the client/patient; and lastly, a difference in interest related to the needs of the social worker and those of the client/patient (Cassel, 1987, p. 558).

Another rather common ethical issue or dilemma for the social worker is what Beckerman refers to as rational suicide which has emerged over the last thirty years or so as a direct result of advances in technology. This is also known as the Right to Die dilemma and involves two distinct areas of concern–first, informed consent or the consent of the client to undergo special or dangerous treatment for a disease, and second, “the right to die without aggressive intervention” (1996, p. 12), meaning that the client has expressed his/her wishes not to be placed on life support in order to extend life. This type of ethical issue or dilemma may force the social worker to make decisions or choices that go against his/her own personal beliefs, but as a professional health care person, the social worker must put aside his/her own feelings for the good of the client/patient.

A third rather common ethical issue or dilemma that most social workers will have to contend with at some point in their careers is making a decision or choice or agreeing to allow a client/patient to die with dignity. One specific area related to this type of scenario is forgoing nutritional support or making the decision not to feed a client/patient that is near death. Sometimes, the client himself expresses the desire to be allowed to die without having to experience the suffering related to force-feeding techniques.

For the concerned social worker, this type of issue or dilemma may force him/her to ask some very pertinent questions regarding their own moral and ethical beliefs and principles. For instance, in regards to self-determination and the quality of life, is it morally and ethically right to allow a client/patient to “opt out” of nutritional support in order to hasten death? For someone who is severely impaired, either physically or mentally, is it morally and ethically right to “maintain nutrition and hydration by artificial means”? (Cassel, 1987, p. 557). Overall, these types of decisions are by their very nature profound and disturbing and as C.K. Cassel reminds us, with an ethical issue or dilemma, the social worker may have to confront the idea that “any decision is wrong, or that two or more mutually exclusive choices are both right, but only one can be chosen (1987, p. 559).

These are but a handful of examples that a social worker may be forced to confront in regards to ethics. However, in today’s world, the clients of a social worker often come from diverse cultural backgrounds with long-held traditions and beliefs that conflict with those of Western society and quite often the moral foundations of the worker himself. Thus, all social workers must be well-informed in order to make the right choices, especially when a client/patient chooses to adhere to cultural tradition instead of the dictates of medical science.

References

Beckerman, N. (1996). Advanced medical technology: The ethical implications for social work practice with the dying. Practice (8)3, 5-18.

Cassel, C.K. (1987). Decisions to forgo life-sustaining therapy: The limits of ethics. Social Service Review, The University of Chicago, 552-564.

Standards and ethics in clinical health care practice. 57-62.