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The ethical dilemma I will discuss will be based on some truth of an event that happened when I was a support worker five years ago in a mental health trust organisation. The patient will be referred to as girl ‘A’ and members of the multidisciplinary team will be referred to as professionals. A very brief description of the girls mental health illness was schizophrenia this can have an effect on a person’s mind in such a way that they can hear voices and send smells that are not real to the human eye.
Other features can include delusional thoughts this is where the person can believe that certain situations and circumstances have happened to them and it is very clear to the person on the contrary it can make a person feel that others do not believe them (CAMHS, 2002).
The ethical dilemma
- Girl ‘A’ was 15 years of age, when she was sectioned under the 1983 Mental Health Act section 2.
- Girl ‘A’ received a letter from a friend at home. This letter revealed that her friend had been raped from girl ‘A’s’ mother’s boyfriend.
- Girl ‘A’ had prior to this letter disclosed to the nursing team that she herself had been raped from her mother’s boyfriend. She decided not to take action for fear of losing the relationship she had recently built up with her mother. At this time the girl wanted her mother to never find out about the disclosure of this rape ordeal.
- The friend told girl ‘A’ that this situation was going to court.
- At this point girl ‘A’ decided it was time to put closure on her own rape ordeal and therefore wanted to go to court and declare her own rape ordeal.
- The ethical dilemma – is should the girl called go to court or not?
Reference – Reading from Leathard, A. & McLaren. (2007) Ethics contemporary challenges in health and social care. The Policy Press: UK.
There are three more approaches which often conflict with many ethical problems they are deontology, conceptualism and virtue ethics (Leathard & McLaren, 2007). It approaches can give directions to ethical dilemmas.
Consequentialism -also referred to as utiliarism discovered by Jeremy Bentham and John Stuart Mill. The aims of this approach are consider the consequences of taking a particular form of action (ibid). All areas of an ethical dilemma using this approach would be given equal weight when considering the outcome (ibid). In health care this approach can be seen to be used when considering decisions that need to be made about the allocation of resources (ibid).
Personal Values my personal values
You will describe your values but there is no right/wrong answer to this. It is basically how you presented your dilemma to the ethic group |Julie.
How does my personal knowledge, culture, and life experience affect this dilemma for you?
What values are in conflict and how has this made you feel?
What were your fears?
Given similar circumstances with another person would the outcome be the same?
how do these impact on the questions you asked
resp. to me as a person
- How and why am I making a choice I am making i.e., what did I think, feel, and what did I do or not do?
- How was my decision making affective by what factors of legislation, standards, policies and organisational policies/procedures and values?
- What other resources would be helpful to me in making the decisions about the dilemma?
- Keep using reflection I think this part Julie is where you have begun to described the different ethical approaches.
Deontology – deon means duty and ology is the science, this approach was discovered by Kantian. The aims of this approach does not consider the consequences rather it acts on what is morally right, in particular deontologists treat the situation or client with respect for individuality which is its greatest importance. This approach would not approve of telling lies to a client even if it was in the best interest. Any decision is made using deontology would have to be based on fact. Duty based theories which would allow the worker and the client to acts of the greatest outcome which would avoid harm. This approach recognises autonomy, trust and the equity of provisions (ibid).
Virtue – derived from Aristotelian ideologies. Thomas Aquinas (1990) defines virtue ethics is not only knowledge but also the approach taken to provide integration using this knowledge for an ethical dilemma situation, an area of “manifestation of ethical professional behaviour” (ibid: 71). Virtue ethics describe a person’s character beliefs and values quality is in actions that they believe are morally sound.
Beauchamp and Childress (1989) describe four ethical principles that should be considered when dealing with any ethical dilemma they are: beneficence, non-maleficence, autonomy and justice (ibid: 72). However these four ethical principles at times can conflict therefore critical judgement is required when choosing a particular procedure to take. These four ethical principles they can provide a framework to assist the worker(s)/client(s) situation by empowering the thinking process, this helps with the decision process of the ethical dilemma (ibid). In virtuous practitioner must take into account the different viewpoints by recognising the potential conflicts that can happen between these four ethical principles. It is therefore recommended that a practitioner makes critical judgements as to which approach would be more appropriate to the ethical dilemma. “Gardiner (2003) comments that the virtuous practitioner is driven by deep desire to behave well and that this approach has a flexibility that can encourage innovative solutions while acknowledging that there will often be elements of pain or regret” (ibid: 76).
So from the ethical dilemma if beneficence was applied the patient’s best interest and wishes and feelings would have been considered using this approach. Although, it could appear harmful to the patient, if the sole views of her situation were considered because this could have had an adverse effect on the best interests of the patient.
Non-maleficence – applying this approach to the ethical dilemma could show how the professional has protected the patient from actual or potential harm; this is particularly successful when the practitioner evaluates his/her knowledge and skills realistically ensuring any form of intervention is taken within their professional capacity. However should the worker feel there could be limitations then they should seek and share this information with the team of professionals caring for the girl? This particular approach may have been applied from support worker/primary care worker’s point of view this is because non-maleficence provides the support worker/primary care worker with more details from the client’s perspective of the situation whereas; a professional may only work with the girl on if few occasions. Therefore the implications of the support worker/primary care worker not sharing information with other professionals can cause great harm to the patient. If the support worker/primary care worker advises the patient “there is nothing more I can do” then this will be harmful and unhelpful to the patient (ibid: 74).
Autonomy – the principle of autonomy and impact on disclosure and confidentiality. However a patient has a right to information about their condition and their situation, the patient’s views beliefs and values should be respected. Although, legally the girl in the ethical dilemma was sectioned under the 1983 mental health act section 2 and therefore their grounds a practitioner must take with regards to an appropriate decision this can conflict the patient’s best interest/wishes and feelings. Using the ethical dilemma in this instance shows when “beneficence or non-maleficence overruling patient autonomy” (ibid: 75). The practitioner will endeavour to the first duty to the patient however the practitioner must balance this duty to the patient with regard to the wider risks and involvement of others. Gillon (2003), autonomy is a component of the other three ethical principles and autonomy should take priority with respect for the patient (ibid).
Justice and equity
“The Aristotelian principles suggest that I trust system should ensure equal and should be treated equally and unequal’s unequally” (ibid: 77). Considering justice and equity to the ethical dilemma the patient may feel the decision to not go to court un-fair. However the practitioner should deliver an Albany’s about the criteria that was used to make the decisions they made about this ethical dilemma. The principles of justice and equity can allow for decisions to be made and distributed according to the patient’s need, merits, capacity or rights. In this situation a practitioner may remind the patient of her rights in respect to a complaints procedure (ibid).
- What are the rights of the child?
- What rights as a person?
- Are there any rights in terms of seeking closure?
- All your doing here is answering and showing Why and what policies may be used with this dilemma.
Julie notes for power
every child matters is a Green paper that was published in 2003 by the government as a response to the death of Victoria Climbie. In 2000 for the children’s act became law from a thorough consultation process and it is this legislation that underpins the legalities of Every Child Matters, by ensuring five necessary outcomes are followed when ensuring the health, safety and well being of children from birth to 19 years. The five outcomes are – being healthy, staying safe, enjoying and achieving, making a positive contribution and achieving economic well-being (Every Child Matters, 2003 Cited in http://www.dcsf.gov.uk/everychildmatters/about/ on 20/10/09 @ 13:05).
What is the organisations point of view?
Ie NHS, CAMHS why do they use them what are the values of these principles to s/u
This report sets out a new vision for the future of mental health and
well-being in England. Based on four principles, it outlines the priorities
we believe should underpin mental health policy for the next decade.
Our four principles for mental health policy are:
- Mental health and well-being is everybody’s business. It affects every family in Britain and it can only be improved if coordinated, assertive action is taken across Whitehall and at all levels of government.
- Good mental health holds the key to a better quality of life in Britain. We need to promote positive mental health, prevent mental ill health and intervene early when people become unwell.
- People should get as much support to gain a good quality of life and fulfil their potential from mental health services as they expect to receive from physical healthcare services. Mental health care should offer hope and support for people to recover and live their lives on their own terms.
- We need a new relationship between mental health services and those who use them. Service users, carers and communities should be offered an active role in shaping the support available to them. With these principles at the heart of policy, we believe we can create a society in which good mental health is nurtured and in which mental ill health is managed well.
As a consequence, our mental well-being will be a core concern of government. Effective action to promote good mental health will be taken among people of all ages and diverse backgrounds. People who experience mental distress will receive timely support to live well and have a fair and equal chance to fulfill their potential.
The actions that would be needed to make our vision a reality are summarized overleaf.
What is sectioning?
Most patients in hospital wards cannot be prevented from leaving when they wish, and their consent must be obtained before treatment is given. The same applies to most patients who are in hospital for psychiatric treatment. They do not object to being in hospital or being treated and are referred to as ‘informal’ or ‘voluntary’ patients. However, the Mental Health Act 1983 allows some people to be detained in hospital. When this happens, they are called ‘detained’ patients and their consent to treatment may no longer be required. This is often known as being ‘sectioned’.
Some people are detained in hospital by the courts after being charged with a crime. (See Mind rights guide 5: mental health and the courts.) However, most people are detained under the ‘civil sections’ of the Mental Health Act, which does not involve a court at all. This booklet sets out what must happen before someone can be detained under a civil section, and outlines some of the effects. Mind rights guides 2-5 describe, in more detail, other relevant information about consent to treatment and what to do if you are being detained and you want to leave hospital.
What is the process for detaining someone under a civil section?
There are two main civil sections of the Mental Health Act 1983, which are used to detain someone: section 2 and section 3. For each section, three people must agree that the individual needs to be detained. Usually, they would be an Approved Mental Health Professional (AMHP), a section 12 approved doctor and a registered medical practitioner.
The two doctors must agree the person needs to be in hospital and recommend detention. Then, the AMHP decides whether or not to make an application for the person’s compulsory admission to hospital. The Nearest Relative (NR) (see below) has the right to make an application. However, the Mental Health Act Code of Practice makes it clear that an AMHP is the preferred applicant and applications by an NR are very rare (the preference for the AMHP as applicant over the NR is re-stated in the new Code of Practice at para 4.28). It does not matter where the person is at the time. They may be at home, in hospital, in a place of safety, or in a police station following an arrest for an alleged criminal offence.
In an urgent situation, someone may be admitted to hospital compulsorily, with only one medical recommendation to support an application (section 4). This is allowed if it is felt the criteria for section 2 (see below) are met, but there is no time to wait for another medical recommendation. The second medical recommendation must be obtained within 72 hours.
It is important to note that people need not have committed a crime to be detained under a civil section. The law allows anyone to be detained under the procedure described above.
What do the different civil sections mean?
Section 2 allows for a person to be detained if they are suffering from a mental disorder and they need to be detained, at least for a limited period, for assessment (or for assessment followed by medical treatment) for their own health or safety, or for the protection of other people.
Detention can last for up to 28 days. The section can’t be renewed, but you may be assessed before the 28 days expires to see if detention under section 3 is necessary.
Section 3 allows for a person to be detained if they have a mental disorder, and it is necessary for their own health or safety, or for the protection of other people, and treatment cannot be provided unless they are detained in hospital. A patient cannot be detained under this section unless the doctors also agree that appropriate medical treatment is available for him or her.
Detention can last for up to six months. The section can then be renewed by six months, initially, and by a year at a time, subsequently (MIND, 2009).
Alan suggest the Mental Health Act could be one.
What rights does she have under this ACT?
Who was present? Consider their positions, charaters, virtues, values ect.
why is it a dilemma
This is what is meant by your code of conduct – this is the link between philsophy and practice it is through the codes of conduct. You will show how the philosophy feeds into codes of conduct and then feeds into practice. Alan explains this is about respect for the person and autonomy. So you need to say A deontology approach would argue this…. and this approach would be used because of this……
Alan gives an example of how to apply this to your scenario: Julie you could argue from one position that deontology is a person in her own right, this does not exist therefore the duty is to the right of this person this is quite deontological this approach also looks at Law, human rights, that sort of thing. Most social workers are this approach All you have to do here is say how and why this approach may be applied to the scenario and where it come from i.e., KANT
This is what is meant by your code of conduct – this is the link between philsophy and practice it is through the codes of conduct. You will show how the philosophy feeds into codes of conduct and then feeds into practice. Alan notes. “A unitarism approach would argue this…. and this approach would be used because of this….Alan example of how to hit this, Consequentialism would suggest you look at the outcomes, if we do not intervene at this point and show some support then this person will suffer damage, they could be harmed that is more this approach and this is the link I want you to make. Most social worker are this approach. All your doing here is saying where did this approach come from how and why would it be used in your dilemma
Virtue ethics = the character of the person, so in the same way that I was arguing with the boys you could argue your point of view with your dilemma Alan. Questions to ask and answer with these approaches are:
What is the thing that makes one of them valid?
“Probably the character of the person doing the argument”! other words you Julie are very dominate and persuading and therefore one needs to ask is your position genuine? I
s it a valid argument?
Are you taking it from integrity (honesty, goodness) or serenity (calm, peace, composure, calmness)? All you doing here is saying where this approach came from and why and how would it be used in this dilemma
Code of ethic & Values
These three streams of values in social work influence our practice and are described as TRADITIONAL (being to the tradition route), EMANCIPATORY (to give independence to free someone from something) AND GOVERNANCE (controlled or overlooked by government) Values. How did the GSCC; BASW; and NOS codes of ethics guide your decision and practice outcomes?
social constructionist view
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