Analysis of a Social Work Practice Dilemma
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ANALYSIS OF A SOCIAL WORK PRACTICE DILEMMA
The ultimate purpose of the Social Work profession to intervene in situations wherein personal factors and environmental influences pose certain difficulties and restrictions for an individual, family, group, or community in their ability to perform their distinct social roles is a basis of many ethical and social dilemmas on the part of the social work practitioner. Social workers deal with people in the aim of empowering them to either restore normal social functioning or acquire new competencies in addressing social problems. This basic requirement elevates the profession into one of the most challenging jobs in society. The primary responsibility of helping people entails the thorough understanding and full acceptance of their distinct characteristics; diverse attitude, skills and interests; and exclusive personal backgrounds. Thus, social work practice is a venue of various dilemmas and conflicts between the professional social worker’s own beliefs and attitudes, the clients’ idiosyncrasies and the standards governing the profession. Accordingly, the social work profession is guided by structured procedures, systematic processes, coded ethical guidelines and dynamic set of skills in order to effectively respond to the uniqueness of every social work case.
ETHICAL DILEMMAS IN RELATION TO INDIVIDUAL RIGHTS AND RESPONSIBILITIES OF THE PEOPLE IN THE CASE
Social work is a complex profession since the practice revolves around empowering people. The ultimate aim of the profession entails that social work practitioners deal with various types and levels of people with their own idiosyncrasies. This reality reflects the possibility of clashes and conflicts in perspectives, priorities and perception of needs. Since social workers basically aspire to assist clients in understanding their issues and identifying the available resources that can help them to address those issues, they are committed to giving the best options. The clients, on the other hand, are usually in a state of confusion and depression when they seek a social worker’s intervention. They may not be in a perfect condition to comprehend their problems and what the social workers believe can be done. Hence, there would be scenarios of ethical dilemmas in social work practice wherein the social worker, the client or any other persons that are involved in the case cannot agree on what to do and how to go about the problem-solving process. More formally, an ethical dilemma is a situation wherein a social worker’s professional perspectives or personal values come in conflict with the demands of duty and must decide which is the most important. They also include situations wherein two risky options are available for the social worker and must decide on what is more applicable to a certain case. Ethical dilemmas inevitably occur in social work practice and must be handled with professionalism to ensure that the case management process can successfully proceed (1999).
The case scenario presents six characters that have interrelated responsibilities and ethical dilemmas to address: Ms. A, her fifteen-year-old daughter, the girl’s birth father, her present partner, the General Practitioner and the social worker from the HIV/AIDS team. First, Ms. A is confronted with various problems that adversely affect her overall social functioning. The client in the case has two primary social roles: as a solo parent to her fifteen-year-old daughter and as a daughter to her ailing father. She has to simultaneously perform the two roles while attending to her personal needs at the same time. Her condition as a HIV positive patient adds to the burden. Ms. A is currently living with a partner who wants to have children but is unaware of her disease. She is torn between the will to fulfill his wish, fear of transmitting the disease to him and decision to keep the disease confidential. Also, if she tells her partner, there is a need to tell her daughter as well which further complicates the situation. Secondly, Ms. A’s daughter basically has the right to know her mother’s condition because she is directly affected by the situation. There is a probability that the daughter would feel that her mother kept something very important from her for a long time while it is her right as a daughter to know about it. Further, if the daughter knows about her mother’s condition, there may develop a closer relationship between them and the school attendance problem might have been avoided because they could have talked about it. Likewise, the girl’s birth father has to understand that even though he is not suffering from the disease and is not connected with his ex-wife anymore, she might need more support from him especially in caring for their daughter. Likewise, the client’s present partner has the right to be informed of her disease because of the obvious sexual relationship that they have which threatens his health as well. Moreover, the client’s General Practitioner and present Social Worker have professional responsibilities in the case. The General Practitioner has the responsibility to provide the social worker with complete documentation of his diagnosis, treatment methods, treatment outcomes, progress of the case and other intervention methods that should be done. The General Practitioner’s concern about the client’s problem with her father’s ailment and her daughter’s school issue should be backed up by professional analysis of how to help Ms. A deal with the problems. On the other hand, the social worker, being the professional presently managing the case, has the greatest responsibility in the case. She is faced with the obligation to help ease the client’s depression through counseling, assess her capacity to perform her roles and discuss her decision regarding the secrecy of her illness which is somehow a vital element of the entire case. The abovementioned circumstances connote two tasks for the social worker: helping the client address her problems with her family while promoting the rights of the people involved in the situation. According to the (2002) a social care worker assists clients to understand their rights, exercise them properly and identify indicators of abuse. In light with promotion of human rights, social care workers also support the client’s right to take control of his or her life and make informed decisions about their problems. (2006) elaborates by saying that social work practice with AIDS/HIV victims is a specialist practice that involves extensive consideration of the human rights, welfare and self determination of the victim and her family as well as their need for empowerment Hence, the social worker in the case has to respect the client’s self-determination while helping her understand the outcomes of her decisions.
Tackling the individual circumstances of the client and her family in the case is the fundamental step for the social worker to do. Ms. A’s personal issues have direct impact on her family’s overall situation so there is a requirement to develop a comprehensive assessment of the family’s case. The assessment should focus on the needs of each of the family members as satisfaction of client needs is the core of social work practice. Identifying the needs can also help the client and her family to capture the complete essence of their situation. (1999) states that contemporary social work practice emphasizes needs-based assessment and client choice. This means that modern-day social workers should be able to clearly identify the needs of each of the clients based on the client’s perceptions and worker’s guidance. The social worker should take into consideration at all times, the ability of the client to analyze his or her situation and be able to derive the primary needs from among several complex issues. It is also important that the social worker is able to make the client feel at ease by showing empathy and willingness to help so that the client would have confidence that his or her problem has a solution. A comfortable client further means that he or she can fully articulate his or her needs, assess the severity of each need, prioritize the most immediate, discuss with the worker the possible solutions and finally decide the best choice of solution . In the case, the social worker has been working with the client for a year and the issue of feelings of ease is not very vital. The year long client-worker relationship must have established a good foundation and open communication between them. However, Ms. A is currently facing new problems than the ones she had when she was referred to the agency for the first time. Her previous problem was the positive diagnosis for HIV which caused the separation from her husband. Now, Ms. A is living with a new man who wishes to start a family considering his innocence regarding the disease. Also, the client has a new concern which is to care for her father who is suffering from Parkinson’s disease. Furthermore, Ms. A has been informed by her daughter’s school officials that her daughter is having attendance problems. The three concerns of the client are distinct from each other in nature but are interrelated and are all contributory to her feelings of helplessness and depression. To start the case management, the social worker has to reinforce the relationship between her and the client and be able to re-stimulate the client’s confidence. The entire case basically requires a family-centered approach since the client’s personal problems are shadowed by her family’s issues. (2002) report that family-centered social work practice follows a framework in understanding and evaluating the needs and resources for family and child well-being. This family centered framework involves three aspects namely the children’s needs for their optimal development and normal functioning; the needs of the entire family to survive and perform their functions successfully; and the numerous resources in the neighborhood, community and environment that can be harnessed to help the family solve their problems (2005) add that the social work profession pursues social justice and works for fostering solid social relationships between the individual and his or her family, and between the individual and his or her environment; between members of a group and between the group and the environment; and among the residents of a community. To do this, social workers facilitate assessment of the interplay between a person’s biological make up, emotional stability, social skills, psychological condition, and social influences to determine the status of the overall social functioning . In the case of Ms. A, there is a need to assess the relationship of various small issues that contributed to the whole scenario. The most basic consideration of the case is the daughter’s need for a more functional family. The destruction of the family structure is somehow influenced by Ms. A’s decision to spare her daughter from knowing the truth about her disease. This decision caused the daughter to lose her father. As a minor, the girl has the right for a complete family that can provide for her emotional, physical, spiritual, social and moral needs. Since, Ms. A solely takes care of her daughter while the father spends holidays with her; the girl is deprived of a father figure in her life. Now, the daughter has attendance issues in school which worries Ms. A. For this problem, the social worker has to make the client understand that her daughter’s behavior is typical of children from single-parent households because of the incomplete discipline that they receive. The social worker has to be careful not to offend the client since the couple’s break up was her decision. In this situation the worker should be able to explain to the client the unique support that a family provides for a normal developing child in the general context and apply it to Ms. A’s daughter. This would make the client think that the worker is not blaming her. The ability of the worker to make the client understand the consequences of her actions without appearing blameful is explained by (2005) when he says that social workers have the responsibility to make the client feel equal to the worker and other people to avoid feelings of social exclusion. If the social worker appears blameful, Ms. A may feel that she is being looked down as a weak decision maker because of her disease. The next issue in the case is the absence of the father which somehow affects the behavior of the daughter. Although the father did not totally abandon his parental responsibilities by spending holidays with his daughter, his absence from the home affects the quality of discipline and upbringing that the daughter receives. As a former husband, he has the right to know the physical conditions of his ex-wife since the diagnosis and how capable she is of caring for their daughter. He is also responsible for giving more support for their daughter since Ms. A has other problems on her own. Infection with Human Immunodeficiency Virus (HIV) is a serious disease and Ms. A’s decision to separate from her ex-husband perhaps out of fear or guilt is a deprivation of his chance to help her as well as jeopardizes the welfare of their daughter. In this case, the social worker should discuss with Ms. A the right of her ex-husband to continuously keep track of her physical condition so that he may be able to understand the burdens of solo parenthood and decide on the welfare of their daughter. The social worker should only discuss about the ex-husband’s right but not force Ms. A to make the ex-husband an important part of the situation since the client already decided to set him free. The General Social Care Council (2002) states that a social worker has the responsibility to respect the client’s individual views and decisions while helping them understand the consequences of their actions. Also, if the social worker is forceful, the client may lose confidence on the truthfulness of her intentions to help and would affect the professional helping relationship. As a social worker, a person must strive to develop and sustain a trustful and open relationship with the client by being straightforward and factual without being domineering ( 2002). Furthermore, if Ms. A. decides to tell the truth to her daughter in order to ease the confusion that she’s feeling, there would be a possibility that her daughter would display feelings of blame, betrayal or hatred towards her for lying about a critical family matter. As an advocate of social justice, the social worker has to be a good intervener in the family situation. She would make the daughter understand that they are not suffering from the disease. She should be able to guide the discussion between Ms. A, her ex-husband and her daughter. Most importantly, she should be able to acknowledge the feelings of the daughter but she need not dwell on her blame and hatred. What the worker needs to do is to tell the daughter that her negative feelings towards Ms. A are typical and acceptable but she should also understand that her decision was a way to protect her. There is also a need for the social worker to emphasize that even if Ms. A is sick she is able to take care of her daughter. (2001) says that an essential fact in social work practice with AIDS and HIV victims is that the practitioners assist the victims to deal with the illness by highlighting their inherent strengths or those reserves of strength that are concealed during the crisis. They give honest appraisals of the client’s ability to deal with the situation upon knowing the diagnosis and the way he or she relates to his/her family and other people who know about the disease . In the case, if the daughter is informed about the disease, the worker has to emphasize that any reaction she has is valid but Ms. A should also be affirmed for her bravery to deal with the situation alone for the last six years. In this way, the whole family would be able to ventilate their feelings about the situation and talk about possible ways to cope. After the issue with HIV is discussed among the family, the social worker has to proceed with the daughter’s problem with school attendance. First, the social worker has to inform the father that Ms. A received a notification from their daughter’s school that she is having attendance issues. Next, the social worker has to make the ex-husband and daughter understand that Ms. A is concerned about her daughter’s school attendance and her worry can possibly have adverse effects on her physical health. Finally, the social worker has to ask the family regarding their reactions and decisions about the situation. The social worker has to reiterate to the family that her role is only to facilitate discussion and guide decisions but the family still has the responsibility to talk about their issues and deal with them. The (2002) states that a social care worker recognizes the right of clients or service users to assess their situation, formulate ways to cope and take risks. The social worker’s key role is to help them to determine and manage possible and actual risks to themselves, their families and other people whom they interact with. In the case, the social worker should not be the primary decision-maker in the family’s problem regarding the school attendance issues of the child and eventually her welfare. She should be able to make the family understand that there is a need to talk about the daughter’s side of the story and her feelings towards her family’s situation. (2002) assert that social workers’ practice with vulnerable families such as those with one or more family members infected with HIV/AIDS recognizes the children’s decision-making capacity and their right to be involved in making decisions about their family’s condition. However, there is also an inherent right for parents or other adult family members to decide in behalf of the children when they are not competent to do so . In Ms. A’s case, her daughter is an adolescent and is in the right age to comprehend the family situation and explain her problems with school. The social worker should be able to encourage the daughter to talk so that her parents would understand why her school attendance is failing. The child has the right to be consulted on the realities of and possible coping strategies to her family’s situation since she is the most vulnerable member. According to the (1997) in most cases when one partner is infected by AIDS and HIV and the other is not, the best option is to separate and the separation has additional consequences. Most significant of these consequences is the children’s reaction especially adolescents. Adolescents, who either have members in their family who are affected by AIDS and HIV or are infected themselves, are likely to react to the situation with resentment. They may develop feelings of guilt for themselves in the case of AIDS or HIV infected adolescents, and disgust or antagonism in case a family member is the one suffering from the disease. These negative responses can lead to poor school performance, isolation and depression . Any reaction of Ms. A’s daughter if she happens to know the disease is a common reaction from a young individual confronted with the complexities of AIDS and HIV. Although she does not know about the disease since now, the fact that her parents separated long ago affected her self-identity and normal development. Upon knowing about the disease that was kept from her for six years, the child would develop more resentment. The social worker can intervene by helping the family, especially the child, to understand the normality of their feelings as well as the need to channel those negative feelings into coping strengths. (2001) explains that social workers can provide the best assistance to AIDS and HIV situations if they can help victims and their families to understand their reactions at a specific time. This means the clients are able to comprehend the authenticity of their feelings and the ways to recover. For instance, AIDS/HIV victim would normally develop depression and grief for losing some aspects of normality and personal functionality; guilt upon knowing that their condition is burdensome to the people must abide by the third value of the social work profession in this situation which is individual worth and dignity. (1997) states that social workers recognize and value the inherent dignity and worth of an individual. They acknowledge the right of a person to be treated with respect despite cultural or ethnic diversity, physical condition, psychological incapacity and other forms of differences. The social worker makes the client see him/herself as a worthy individual who can resolve his or her own needs and make changes on his or her personal circumstances . In the case, the social worker should talk to Ms. A of her worth and inherent rights as an individual. There is a need to make her understand that her feelings of depression and grief normally reflect an HIV-infected person’s reaction for having the disease that can forever affect normal bodily functions. The social worker should give Ms. A ample time to grieve while constantly providing expressions of hope. Next, the social worker should make the client understand that having the disease does not mean that she chose it. Then, fear of death must be addressed. The social worker should make the client realize that the disease should no be viewed in the long-term period but the present situation should be the focus. When the social worker is able to do all these things, the client can understand the normality of their negative feelings and will be able to clearly think on coping strategies. After addressing the emotional issues of the client, the social worker must tackle the concept of social support. The ex-husband and the daughter come in on this phase of the helping process. The (1997) states that social work practice with AIDS/HIV-infected clients usually revolve around the family as the best social support. The social worker’s role is to make the client understand the need to involve the whole family so that her coping mechanisms would be strengthened. The family must also be oriented on the needs of the client and what each member can contribute to helping the client deal with the situation (p. 66). In the case, the ex-husband knows about the disease and if the client decides to tell the daughter, there is a possibility that she would feel stronger because of the additional strength that they give. Furthermore, Ms. A’s concern with her father’s deteriorating physical condition can also be resolved if her entire family is involved. The social worker should be able to make Ms. A’s ex-husband and daughter to understand that the client is currently emotionally and psychologically affected by her father’s fight against Parkinson’s disease which the general practitioner fear can aggravate her physical condition. When the daughter and ex-husband become aware that Ms. A’s concern with her father’s health is detrimental to her physical condition, they may become more supportive and even helpful in coming up with possible solutions to the crisis so as to ease her feelings of helplessness. Solutions may include assuring the client that either of the ex-husband or the daughter can monitor her father’s health or contact any relative who can look after the ailing man. (2001) affirms that no matter how complex AIDS or HIV is, people suffering from the disease are always assisted to cope if the broader family is involved in the crisis. The client should be made aware of his/her need for a social network which include her life partner, children, friends and relatives that can convey a long-term commitment of caring for her, render emotional support, provide guidance and contribute material assistance. The social worker must be able to cite examples of AIDS or HIV cases from previous experiences wherein the patient’s honesty about his/her condition brought the family closer together and helped the patient cope more effectively in order to enlighten Ms. A. However, the decision to either disclose or keep the disease from other relatives depends on the client and which the social worker must respect (. The purpose of social support from family in the case is to safeguard the welfare of the client who has been solely dealing with her disease for too long while being concerned with health conditions and personal problems of other members of her family.
Another important consideration of ethical dilemma in the case is the issue with Ms. A and her present partner. Ms. A’s present partner is unaware of her condition and his wish to have a child is another cause of emotional disturbance for the client. As a person, the client has a right to form relationships and establish a family despite her physical condition. The se (1997) declares that many women suffering from HIV or AIDS are confronted with the difficulty of deciding whether to become intimate with another or have children. This is because the decision to have a child poses certain risks for the woman and the baby such as probability of infection transfer, the fact that HIV-infection is fatal and the patient may not see the child grow up anymore, and the fear of being resented by the partner. Thus, many medical practitioners advise AIDS and HIV victims to either delay pregnancy until a through diagnosis of the condition has been made or totally avoid it if the condition is severe . In the case, Ms. A is emotional when she discloses that her new partner wants to have a child but she does not reveal any personal intention of having another child. The social worker cannot decide to intervene without knowing the diagnosis of the infection, its level of severity and possible treatment options. Thus, the social worker has to first collaborate with the general practitioner and other medical professionals in order to get the full diagnosis of Ms. A’s condition. A professional social worker recognizes other expertise of professionals from various disciplines and seeks their opinion and guidance when the case warrants it (2002). The social worker should be able to thoroughly discuss the matter with the general practitioner who handled Ms. A’s case first so that they can both pool their expertise and knowledge in coming up with possible solutions to the problem. After consulting with medical professionals and if necessary, with supervisors, the worker must be able to understand the severity of the client’s condition and the best ways to deal with it. However, the (1997) asserts that no matter what the circumstances are, HIV and AIDS victims have two options in dealing with partners who do not know about the disease: tell them to get their stance on the matter or separate (p. 72). Either way, the social worker must be able to provide ongoing support by giving the client and her family access to continuous assistance from medical providers, social organizations dealing with AIDS and HIV, counseling and therapies, and normal family activities to make them feel optimistic that the entire situation is bearable.
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