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Ethical dilemmas in social work: A case study

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New Hanover County Senior Resource Center: Ethical Dilemma

What are values, ethics, ethical dilemmas and a code of ethics? Values relate to principles and attitudes that provide direction to everyday living. Values also refer to beliefs or standards considered desirable by a culture, group or individual (Merriam, 2003). On the other hand, ethics means a system of beliefs that constitutes moral judgment. In essence, ethics are moral principles (Barsky, 2010, p. 12). An ethical dilemma is when a person is faced with a choice between two equally conflicting moral principles, and it is not clear cut which choice will be the right one. (Barsky, 2010, p. 6). In other words, adhering particularly to one principal might result in the violation of the other. Finally, ‘a code of ethics’ is an explicit statement of the values, principles and rules of a profession, which acts as a guide for its members and their practice (Code, 2008). In every occupation, professionals are faced with ethical dilemmas. Dilemmas at workplaces can sometimes be the hardest decision to make in life; however, as a professional we must take the proper steps to move further and not jeopardize our license or career. As a Bachelor of Social Work intern at the New Hanover County Senior Resource Center, ethical dilemmas are easy to come by.

Description of Ethical Dilemma

An ethical dilemma occurred on November, 20th of 2014. The client that this dilemma revolves around, is on the Senior Resource Centers Home Delivered Meals program. The program serves home-bound elderly citizens age 60 and over, and they receive a lunch Monday through Friday, prepared at the center nutrition site by a local catering company (Nutrition, 2015). This specific client has been receiving meals since 2006, and in November it was time for a reassessment to be done. Reassessments are done every six months to make sure the clients are still eligible to receive meals.

I and my field instructor, Jean Wall, visited this client at their home. I knocked on the door, and after a few seconds I could smell marijuana wayfaring in the air coming out of an open window beside the door. The grandson of the client opened the door, and said the client was not there. He looked to be older than 18. My field instructor asked where the client was, and the grandson changed the story to the client was in the bedroom taking a nap. The grandson had red eyes, and was slurring his words, which are symptoms of marijuana use. Added with the smell of marijuana coming from inside, it was clear he had been smoking it. After leaving the clients home, I was unsure how to proceed with what just happened. The drug use in the home could negatively affect the clients overall health and well-being, but is it within our jurisdiction, as social workers at the senior resource center, to make a report?

The Code of Ethics of the National Association of Social Workers, also known as NASW, expresses the values and principles of the profession. By having values and principles that guides our practice, this assists our work, and helps us to act in ethical ways. In short, values and principles provide a guide and standard for ethical practice in social work (Barsky, 2010). The ethical standards that conflict, in this ethical dilemma, are standards 1.01 and 1.07. 1.01 states that a social workers primary responsibility is to promote the wellbeing of clients. Standard 1.07 part ‘a’ states that social workers should respect clients’ rights to privacy (Code, 2008). Standard 1.07 is also in conflict with North Carolina possession laws. In North Carolina, Marijuana is classified as a Schedule VI Controlled Substance, and possessing marijuana in North Carolina is considered a Class 1 misdemeanor under N.C. Gen. Stat. 90-95(d)(4).

Stakeholders

Every decision we make affects other people. Social workers have a moral obligation to consider the ethical implications of their decisions on others. Each person, group, or institution likely to be affected by a decision is a stakeholder with a moral claim on the decision maker (Barsky, 2010). There are individuals, groups, and organizations that can be affected by the ethical decision made concerning this client who lets their drug using grandson live with them. First of all, the client is most likely to be affected by the decision because this ethical dilemma revolves around the client and questions what is best for the client. The grandson is also a stakeholder. More individuals that are stakeholders are Jean Wall and myself, because we are the social workers involved with the case. The organizations that are also stakeholders are the New Hanover County Senior Resource Center, the Apartments where the client lives, The Department of Social Services, and The Wilmington Police Department.

Possible Courses of Action

Identifying all possible courses of action and the participants involved in each, along with possible benefits and risks for each, is important for making the best decision when it comes to ethical dilemmas. In this case, there are three possible courses of action; doing nothing, reporting the drug use, and discussing it with the client.

The first course of action, doing nothing, entails not reporting the drug use or confronting the grandson or client with the matter. Essentially, the participants with this option are the social workers involved with the case, which are Jean Wall and myself. We would document the home visit like we are required to, but no further investigation would take place concerning the drug using grandson living with the client. The benefit to this option is that the client gets to have the grandson continue to live there, which may help if she has an accident or medical emergency, where she would need help calling 911 or getting to the hospital. The risks of this option are that the grandson may become abusive as an effect of the marijuana use, and that the client’s health could be negatively affected from inhaling the smoke.

The second course of action, reporting it, entails making a report of the drug use to the police department, or to Adult Protective Services. The participants in this option are, myself, my field instructor, the client, the client’s grandson, the Wilmington Police Department, and the Department of Social Services. The benefits for this option are that the client is no longer living in an unhealthy environment, and that, if the police reprehend the grandson for possession, then drugs have been taken off the street. The possible risks are that the client is displeased and makes complaints to the agency, and another risk is that the police can do nothing about the drugs being in the home, and in retaliation, the client may want nothing to do with the senior resource center anymore.

The third course of action is discussing the issue with the client, and letting the client decide what they want to happen. Participants is this option would be the client, the grandson, myself, and my field instructor. The benefits are that the client becomes aware that there is an issue, and starts to take steps to get the grandson out of the house, and that the grandson will be aware that this could lead to a bad environment for his grandmother. The possible risks are that the client may get angry with us trying to get involved, the grandson may get violent and defensive, and that the agency may lose the client.

Analysis of Courses of Action

The courses of action mentioned previously need to be thoroughly examined. Doing this entails going over the reasons in favor of and opposed to each possible course of action. Option number one of doing nothing, entails not reporting the drug use or confronting the grandson or client with the matter. Reasons in favor of this option include the Code of Ethics ethical standard 1.07. That standard prohibits social workers from sharing client’s personal information (Barsky, 2010, p. 98). Social workers should respect the client’s rights to privacy, and this applies to this option because we would be protecting the clients privacy by not reporting the drug use. Another reason in favor of this option is that it’s not in our jurisdiction to do, or say anything, about the apparent drug use because there was no evidence of elder abuse, and we could see no actual drugs. The reasons opposed to doing nothing revolves around the Code of Ethics standard 1.01. It is a social workers responsibility to promote the wellbeing of clients. In this case, doing nothing would not adhere to following that standard.

Option number two, of reporting it, entails making a report of the drug use to the police department, or Adult Protective Services. One reason in favor of this option is that it would adhere to the ethical standard 1.01 of promoting the clients wellbeing. Another reason in favor of this option is because it would follow with my own personal value about being against drug use. Additionally, possession of marijuana is against the law in North Carolina. Reasons opposed to reporting is that it would compete with ethical standard 1.07 where it states that social workers have to respect client’s rights to privacy. Also, reporting this issue to police would go against the ethical principle of dignity and worth of the person. The NASW Code of Ethics (2008) states that, “Social workers seek to enhance clients’ capacity and opportunity to change and to address their own needs”.

Finally, option number three, of discussing the issue with the client, and letting the client decide what they want to happen, has reasons in favor of and against it. Reasons in favor of talking it over with the client includes the ethical theory that the client is the expert on their own life, and the ethical principal of dignity and worth of the person. Option three adheres to this theory and principal because we would be giving the client the opportunity to change and to address their own needs instead of making the decision for the client, without the clients consent. A reason opposed to this option is the legalities involved with North Carolina law. Drug possession is against the law, so just discussing the issue with the client may not be enough.

Consultation

Consulting with colleagues and appropriate experts about ethical dilemmas can aide in the decision making process. With this case, I consulted with Jean Wall, who is my field instructor, and then I consulted with another intern at the New Hanover County Senior Resource Center. The reason I consulted with the other intern was to try and get a sense of what her opinions on the case are, and to see what her decision would have been. The outcome of that consultation was that she was stumped on what to do also, but that she agreed with me on that it was an issue. She was not sure what should be done about it either. Next, I consulted with my field instructor about the home visit in general, then asked what should be done with the issue. Jean stated that, first, it was not part of our job to advise our clients on what should be done. We are to only give them the resources and tools they ask for. Second, that since there was no sign of abuse or neglect we could not make a report.

Determining a Course of Action and Documentation

The course of action that was chosen was to do nothing about the issue. This option was chosen because there was no sign of abuse or neglect, so we could not make a report to Adult Protective Services, and because we did not actually see any drugs while we made the home visit. The Senior Resource Center does not have a particular method of documenting ethical dilemmas. Documentation is done for all client interaction with the agency and staff. I documented the reassessment, like I would any other reassessment, once we could get in touch with the client and do the full reassessment.

Ongoing Evaluation and Documentation

After making the decision, monitoring, evaluating, and documenting the decision comes next. After documenting the first home visit we did to see the client, my field instructor set up another appointment with the client, and did the full reassessment for Home Delivered Meals. After the assessment, my field instructor and I debriefed on how the second home visit went. My field instructor stated that the house was very cluttered and smelled of smoke. The grandson was still living with the client, but he was out of the room for the visit. The client was found to still be eligible for Home Delivered Meals, and in six months, my field instructor will conduct another reassessment.

Conclusion

In conclusion, an ethical dilemma is a conflict of moral principles, occurring when a person is faced with a certain situation where adhering particularly to one principal might result in the violation of the other. Over the course of this internship, I have found that dilemmas at workplaces can sometimes be the hardest decisions to make in life; however, as an aspiring professional I must take the proper steps to move further. While interning at the New Hanover Senior Resource Center, this ethical dilemma occurred during a home visit. The client’s grandson had been smoking marijuana within the client’s home. The reason this was an ethical dilemma was because two standards in the NASW Code of Ethics were in conflict, specifically 1.01, and part ‘a’ of 1.07. In the end, my field instructor and I were not able to do anything about the smoking of marijuana in the client’s home. We could not report it to Adult Protective Services because there was no sign of neglect or abuse to the client. However, there will be further monitoring of the situation due to the client still being on the Home Delivered Meals program, and having to do reassessments every six months.

References

Barsky, A. E. (2010). Ethics and values in social work: An integrated approach for a comprehensive curriculum. Oxford: Oxford University Press.

Code of Ethics of the National Association of Social Workers. (2008). Retrieved February 7, 2015, from https://www.socialworkers.org/pubs/code/code.asp

G.S. 90-95. (2015). Retrieved February 7, 2015, from http://www.ncleg.net/EnactedLegislation/Statutes/HTML/BySection/Chapter_90/GS_90-95.html

Merriam-Webster, Inc. (2003). Merriam-Webster's collegiate dictionary. Springfield, Mass: Merriam-Webster, Inc.

Nutrition. (2015). Retrieved February 7, 2015, from http://src.nhcgov.com/services/nutrition/


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