Ethical Dilemmas In Social Work

Ethics is referred to the moral principles which include defending, systematizing and recommending concepts regarding wrong or right behaviour of a person or a situation (Grace, 2017). The ethical codes are important to be abided in the social work so that the social workers are able to deliver services that established the mentioned standards of practice by the law as well as is able to protect the rights and dignity of the service users. However, in social services, ethical dilemmas are inherent to arise due to conflicting values of the service users (Kangasniemi et al. 2015). Thus, in this essay, the ethical dilemmas being faced by Gifty are to be identified by using ethical theories. Moreover, the ethical principles to be abided by along with professional and personal values in Gifty’s case are also to be discussed. The SIAC model for ethics is also to be used for principle reasoning of the ethical issues to be faced by Gifty.

On analysing the case study of Gifty (Appendix 1), it is seen that the ethical dilemmas being faced are related to her health, finances and socialisation. The ethical theories are to be applied in this case to develop decision regarding what is wrong or right to eliminate the dilemmas. As mentioned by Deacon and Macdonald (2017), ethical theories refer to the rational proposals which act as standards of guidance regarding the decisions to be made by the social worker of healthcare practitioners by evaluating the condition of the service users. Thus, to develop decisions regarding Gifty, the Deontological and Utilitarian ethical theories are to be used. This is because these two ethical theories are distinctive in nature which helps to make effective ethical decisions and is most frequently used by social workers to tackle ethical dilemmas experienced while caring for the service users.

The Deontological theory refers to the theory that put emphasis on the relationship between morality and duty of the actions of humans (Williamson et al. 2018). This means that deontological theory judge whether an action is wrong or right on the basis of moral code of principle. Thus, the social workers taking a deontological approach for resolving dilemmas raised for Gifty would focus on the actions which support her to control her own life for achieving the mentioned objectives without making logical analysis of the decision. This is because according to the theory the moral or ethical duty is to respect and honour the obligations of the service users (Mallia, 2015). Moreover, the National Association of Social Workers (NASW) Code of ethics 2008 informs that it is the professional duty of the social workers to respect the service users to control their life along with helping them to clarify their objectives of life (www.socialworkers.org, 2008). Thus, the social workers by abiding with the NASW and taking a deontological approach is to help Gifty to attend college in fulfilling her ambition without thinking of the imminent consequences. This is because by attending college Gifty may show improvement in self-confidence, social interactions and others with development of better cognitive skills.

On the contrary, supporting autonomy by following the deontological theory would make the social workers lead Gifty to be vulnerable to face harm or abuse while attending college. However, following deontological theory would lead the social workers accomplish self-determination principle mentioned in the NASW. The case study of Gifty also informs that she has wished not to be resuscitated in case she met with accident and has developed wish to manage her own finances. According to the Mental Health Capacity Act 2005 the mentally ill individual is able to take their own decision if they have relevant information about the consequence of her decision (www.legislation.gov.uk, 2005). Moreover, the Human Rights Act 1998 informs that all the individuals irrespective of any discrimination are allowed to take their own decision (www.legislation.gov.uk, 1998). Thus, the social workers taking deontological approach require supporting Gifty to take power of her own finances and life as she is able to inform reason behind such demands. This is because in this way she would be able to be independent and buy things on her own as well as would be able to suffer less pain and trauma in case she met with an accident. It would also lead social workers following deontological theory to ensure dignity and respect to Gifty thus abiding by the principles of the theory.

The strength of the deontological theory is that it allows one to adhere to the obligations and offer respect along with honour to the individuals (Poikolainen, 2017). Thus, social workers following the theory would lead Gifty to fulfil her self-determining thoughts, in turn, providing honour and respect to her by supporting her decision to make her happy and feel dignified. As argued by Collins et al. (2015), the limitation of the deontological theory is that it leads individuals to take decisions in a callous and uncaring manner without rational thinking. Thus, by taking this approach social workers are going to ignore the negative consequences such as harm, irresponsible expenditure and others to Gifty to give her assurance to manage her own finances and life. In contrast to Deontological theory, the Utilitarian theory informs that the moral decision or actions are to be taken by considering the best possible positive outcome for the individual (Schriver, 2017). Thus, the social workers who are going to take the utilitarian approach are going to take decision which is best for Gifty and her family as in this case the greater number of family member is prioritised over Gifty’s autonomy. Therefore, social workers following the approach are not going to allow Gifty to get the admission to college as they feel that providing her autonomy to get into college would get her exposed to physical and mental abuse in the institution. Moreover, Utilitarian approach followed by social workers is going to make them avoid self-financial management assurance to Gifty as she would spend lavishly and irresponsibly and avoid Gifty’s fulfilment of wish regarding not to be resuscitated after death as it would lead trauma to the family.

The strength of the Utilitarian theory is that it leads to take the moral decision that benefits greater proportion of people by allocating limited resources in an effective manner (Jones et al. 2016). Thus, application of the approach would lead to focus on good of Gifty along with her family members. However, the limitation of the theory is that it acts to prevent rather than achieving a result which may lead to a negative outcome (Jones et al. 2016). Thus, following the theory would lead social workers to compromise the self-determination and autonomy of Gifty. The other limitation of Utilitarian theory is that it does not allow all to be happy (Boutilier et al. 2015). This is evident as taking away autonomy of Gifty is going to make her feel deprived and violated of her human rights.

The ethical principles include respect for autonomy, nonmaleficence, justice and beneficence (Congress, 2017). The ethical principles of autnomy and beneficence are chosen for assuring moral value to Gifty as by abiding it would leads to take decisions that going to avoid Gifty from any form of harm and abuse. The beneficence refers to taking positive step for helping individuals by taking actions that is the best interest for the individual (Reamer, 2015). Thus, the social workers following this principle would develop care services for Gifty by understanding the concept of bereavement. This is because developing concept regarding the fact would lead them to offer empathetic services to the Gifty to help her cope with bereavement. The bereavement services to ensure beneficence to Gifty is required as she is suffering from death of her parents resulting her to face trauma which is evident from her change in behaviour and increased need to make own decisions that were not previously shown by her. As mentioned by Jones et al. (2015), finite loss is referred as parent’s death whereas the non-finite loss refers to sensory impairment. Thus, the social workers are to react empathically and show act of kindness or beneficence by delivering bereavement services to assist Gifty to cope with the loss of her parents by considering her psychological, emotional and mental impact of the loss. As argued by Boyraz et al. (2015), helping individuals to cope with any form of loss assist them to prevent from self-harm and ensure control over life. Thus, through beneficence helping Gifty to cope with the loss would lead her to preserve her identity and dignity in life.

The respect for autonomy allows capacity to the person to make un-coerced and informed decision (Havermans et al. 2017). Thus, by respecting the autonomy of Gifty would lead the social workers to allow her to take her own decisions in life allowing her to execute self-management of finance to use her money in an independent way. Moreover, respecting autonomy by the social workers for Gifty is going to get her fulfil her ambition to get into college and it is going to help her face less face and trauma as it going to support her wish of not getting resuscitated after accident. The respect of autonomy by social workers would also lead them to allow Gifty live on her own terms without facing any interference from the family. As commented by Hudson (2016), justice refers to the moral rightness which is based on fairness, equity, rationality, law and others. Thus, offering justice to Gifty’s situation may lead her to protect her dignity as well as wealth being offered to her by her parents. The nonmaleficence informs that it is better to do nothing than to take actions that are harmful (Thiessen et al. 2015). According to this ethical principle of nonmaleficence, autonomy to Gifty is not to be allowed. This is because there is dilemma regarding it that it may harm the individual or benefit her. (Appendix 2)

The ethical model in social work is seen to offer guidance to social workers or practitioners in making decisions regarding any situation on the basis of principled reasoning (Coady and Lehmann, 2016). In this study, the SIAC model is to be applied for determining best outcome for Gifty as it helps to develop solutions by thorough analysis of the situation that has least negative consequence for solving the dilemma and problems faced by the individuals (Icheku, 2011). However, the ethical model by Robinson and Resser is not to be used as it is focused on making solution without summarising or analysing the situation or considering if the solutions have least negative consequence (Robinson and Reeser, 2002). The SIAC model stands for summarization, identification of dilemmas from different perspective, application of relevant legal and ethical principle and consideration of all option to reach solutions (Icheku, 2011). In summarising the facts in the case scenario it evident that the key issues are socialisation, finance and health related to Gifty. According to the model, the identification of dilemmas from different perspectives informs that dilemma exists regarding Gifty’s autonomy as it would result her to be independent but make her vulnerable to be taken advantage by the society, she would squander money and face abuse by the individual at college. However, not offering her autonomy would make to violate her human rights but would put her under the protection of the family.

In the application stage, all standards and laws are to be considered for the ethical problem (www.hcpc-uk.org, 2016). According to the Health Care and Professional Council (HCPC standard 6), all steps are to be taken to reduce risk of any harm to the service users (www.hcpc-uk.org, 2016). Thus, this standard set by the HCPC is to be considered while resolving ethical problem faced by Gifty. Moreover, the HCPC standard 1 informs that decisions are to be taken for the service users by respecting their privacy and dignity (www.hcpc-uk.org, 2016). The Mental Health Capacity Act 2005 informs that adults are able to make their own decision unless it is proved they are incapable (www.legislation.gov.uk, 2005). Thus, these legislation and principles are to be followed while framing solutions for ethical dilemma faced in case of Gifty. In the consideration stage, the solutions that have least negative consequence are to be selected for the service users to resolve ethical dilemma (Icheku, 2011). Thus, in this stage, the solutions for resolving ethical dilemma related to Gifty would involve offering her partial autonomy to take control of her finances and offer responsibility to the family to take care for her health and socialisation according to the model.

The personal and professional values are to be considered in order to resolve ethical issues so that effective quality care can be provided to the service users (Marlowe et al. 2015). The professional values in social work include core standards to be followed in a profession such as integrity, ethics and others to offer quality care to service users by meeting all standards, principle and legislations (Miloradova and Ishkov, 2015). On contrary, personal values are referred to the individual’s own perception what is right or wrong within their culture, religion, ideology and others (Banks, 2016). Thus, the professional values are able to create conflict with personal values in social work because what is ethical to execute in a profession may not be supported by an individual's personal values (Craig et al. 2017). Therefore, the social workers are emphasised to manage their individual values while working in the professional field as person value is integrated in one’s life and they cannot completely disintegrate from it (Clarke, 2018).

The professional values of the social workers are informed by Health Care and Professional Council (HCPC), Personal Capabilities Framework (PCF), legislation and others. The HCPC standard 1 informs that consent of the service user is required for any nature of services or treatment or care is provided to them (www.hcpc-uk.org, 2016). Thus, the social workers while caring for Gifty are to make decisions which are approved by Gifty to follow proper professional value. The Knowledge and Skills Statement (KSS) for social workers informs that it is the professional duty of the social workers to be knowledgeable and have skills to provide person-centred care, safeguarding and others to the service users (assets.publishing.service.gov.uk, 2018). Thus, according to this professional code, the social workers involved in caring for Gifty are to be trained and have effective skill and knowledge to deliver quality care and services to Gifty. The Professional Capabilities Framework informs that social workers are to behave as a professional while caring for service users (www.scstrust.co.uk, 2018). Thus, the social workers according to PCF are to offer services to Gifty in a professional way by meeting the professional code and standards mentioned for their work. The personal values such as religious, cultural, sexual, racial and others may affect the care quality for the service users by creating discrimination. As mentioned by Morales and Giugni (2016), racism exists in Britain due to which individuals with black skin are discriminated in the society to be lower than white individuals. Since Gifty has black skin colour thus social workers taking her care require avoiding racial values to interfere in their professional life so that they do not discriminate her on skin colour and offer her care at par with the white individuals. As asserted by Oxhandler et al. (2015), religious thoughts often influence individuals to execute activities that are not professionally ethical. Thus, social workers require controlling their religious values to get involved while caring for Gifty to ensure her quality care services. (Appendix 3)

The above discussion informs that social workers following deontological approach are going to ensure autonomy to Gifty as it is the judged to be right according to moral code. However, the social workers resolving the dilemma through Utilitarian approach is going to take best suitable strategies to create positive action for most individuals in Gifty’s situation. The principles of autonomy and beneficence are abided by while resolving the ethical dilemmas for Gifty. The SIAC model is used in Gifty’s case instead of Robinson and Resser model as it helps in developing solution that has least negative consequence while the later do not implement any such consideration while framing solution. The personal and professional values of social workers are to be effectively controlled so that no conflicts between the two values are raised and effective quality care is provided to Gifty without hindrance.

References

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Appendix 1:
Background

Gifty is a 28-year-old single, black British, female who has a mild learning disability and both sight impairment and hearing loss. Up until 9 months ago, when her Father passed away, she lived with and was supported by both parents. Within 6 months of her Father’s death, her Mum became ill and subsequently died. Upon the death of both parents, Gifty’s family collectively agreed to provide care and support.

The family consists of Gifty’s older brother aged 41 *Ted*, an older sister aged 43 *Rose* and a younger sister aged 32 *Rachel*. Ted and Rose have partners and children of their own. Rachel has moved into the family home to support Gifty. Rachel works full time as a carer in a residential home.

Gifty attends a local day centre four days per week and really enjoys this. Gifty is in receipt of a personal independence budget (PIP) which her parents previously managed for her.

Current situation

Gifty’s siblings have contacted the Community Learning Disability team for support and an assessment of need under the Care Act 2015 (S’s 9-13), as they were concerned about Gifty’s change in behaviour since the death of their parents. Their concerns are that, whilst Gifty is happy that Rachel has moved into the family home, she has advised the family she now wishes to make more of her own decisions. These incorporate three areas, health, socialisation and finances. Gifty has told her siblings that she recently visited the GP accompanied by a support worker at the day centre and completed an Advance Medical Directive indicating she does not want to be resuscitated (DNR) if she is involved in an accident. This followed an incident in which her best friend at the day centre was involved in a Road Traffic Accident and became paralysed, in a wheelchair and without speech; by using a communication board, Gifty’s friend has told Gifty, she would rather not be alive than paralysed and without speech. The family are upset that this occurred without their knowledge. Gifty also wants to attend the local college, Although Gifty is open to suggestions regarding what course to take, she is adamant she wants to meet more people and make more friends. Additionally, Gifty wants to manage her own benefits and finances just like some of her other friends at the day centre. Gifty’s family do not agree with Gifty’s decisions. They feel that Gifty lacks capacity (Mental Capacity Act 2005), is too vulnerable to make her own choices and would be put at risk by mixing with other people who could take advantage of her.

Appendix 2:

As commented by O'Hare et al. (2015), mentally and physically disabled people are often abused or harmed for taking advantage of them by individuals in society as they are thought weak. Since Gifty is both hearing and sight impaired along with has mild learning ability thus offering her autonomy may make her exposed to being taken advantage of or abused or harmed by the society or individuals in the college according to principle of non- maleficence. According to this principle, the social workers following non-maleficence would not offer her full autonomy as it would result to neglect her family who is showing trust resulting them not being able to protect from abuse or harm that may be caused to her as a result of being autonomous. In contrast, Gifty may not show trust towards her family after her parent's death which shows that respecting her autonomy would lead her to be free thus creating a situation of dilemma.

Appendix 3:

The Equality Act 2010 informs that no discrimination is to be made while providing care to the service users irrespective of race religion and others (www.legislation.gov.uk 2010). Thus, the social workers require avoiding discrimination of Gifty on the basis of skin colour and need to offer her proper care like other British nationals. The Care Act 2014 informs that all individuals are to be offered effective care with quality standards (www.legislation.gov.uk 2014). Thus, the social workers for Gifty are to follow the legislation to offer her services in a professional way. The HCPC standard 5 informs confidentiality is to be respected and standards 7 reports safety concern of the service user is to be informed to particular individual or authorities (www.hcpc-uk.org, 2016). These are to be abided by the social workers to professionally act for caring for Gifty.

As argued by Turner and Maschi (2015), often female in the society are regarded lower than men as they are thought as depressed sex of the society. The social workers while caring for Gifty avoid get influenced by such thought so that they are able to professionally offer care to her at par with male service users without any form of sexual differences.

Appendix 4:

HCPC Standards of Conduct, Ethics and Code:
1. Promoting as well as protecting the interest of service users
2. Communicating effectively and appropriately with the service users
3. Working within limited knowledge and skills
4. Delegating properly’
5. Respecting confidentiality
6. Managing risk
7. Reporting safety concerns
8. To be open when things are going wrong
9. Trustworthy and honesty
10. Keeping records of work

Appendix 5:

The Knowledge and Skills Statement (KSS) for social workers informs that person-centred services are to be provided to all service users without any discrimination. Moreover, safeguarding of all service users are to be ensured by social workers so that they do not face abuse of harm from the society. The service users with mental health issues are to be provided effective quality care and they are to be respected and empowered along with their dignity and autonomy are to be assured.

Appendix 6:

The Professional Capabilities Framework for Social Work informs the following domains are to be abided by social workers:

Professionalism
2. Values and Ethics
3. Diversity
4. Rights, Economic well-being and Justice
5. Knowledge
6. Critical analysis and reflection
7. Intervention and Skills
8. Context and organisations
9. Professional Leadership

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