Monday, November 28, 2011

Human Services Ethic: Factors Relevant to the Case: Written Assignment

Desdery J. Masao


Reamer page 51 tells us that the purpose of the NASW code of ethics provides an impression of code’s main function and principle for dealing with ethical matters and or dilemmas while practicing social work. These ethics brings broad ethical principles and reflect the profession’s core values by establishing ethical standards to guide social worker professions. Also ethics assist professionals to identify significant professional obligations, when conflicts or ethical dilemmas arise; they emphasize social work values and ethics as a mission, whereby general public can hold the social worker profession responsible. Finally, these ethics and values formulate standards that the social work profession can use to asses whether professionals have act upon an ethical misconduct.

In the given case between renal social worker, physician and Mrs. B’s decisions to terminate hem dialysis service, I see a bunch of ethical dilemmas and value issues. For example, Kenyon page 63, NOHSE ethics codes of the human service professional’s responsibility to clients, statement eight state that “The client’s right to self-determination is protected by human service professionals. They recognize the client’s right to receive or refuse services.” Statement four states that “If it is suspected that danger or harm may occur to the client or to others as a result of client’s behavior, the human service worker acts in an appropriate and professional manner to protect the safety of those individuals. This may involve seeking consultation, supervision, and/or breaking the confidentiality of the relationship.” Also Reamer 2001 page 53 NASW code of ethics states that Clients have a right to interrupt or terminate service.

On this case Mrs. B has raised an ethical and value dilemma. Her request to terminate service has been taken by Mrs. B’s mother unethical, suicidal, and bad example due to their family values and spiritual belief. Whereby to the physician, social worker and somehow family is been taken as confusion and alternating depression. This has ranked this matter to the category of ethical dilemma issue.

Mrs. B’s mother is horrified by Mrs. B’s decision that requested to terminate her treatment. Kenyon page 63 NOHSE statements eight and statement four, also Reamer 2001 page 53 NASW codes of ethics states that Clients have a right to interrupt or terminate service, seems to clash. According to the case materials, Mrs. B while discussing with her case worker she said that "I'm tired of fighting. Living on this machine is worse than dying” and further that she wanted to terminate treatment, this is taken by family and professionals as suicide. Whereas NOHSE statement eight gives Mrs. B a right to refuse this treatment, and at the same time statement four gives social worker professionals a right to act appropriately and protect Mrs. B’s life from harm due to her decision. This can be done by involving consultation, supervision, and it can also lead to breach of confidentiality. 

In this case I believe social workers have to choose what is right for the client and move swiftly and boldly. Reamer page 44 said that hard cases, such as Mrs. B’s, are the one which prima facie duties clash and social workers must choose between two mismatched but usually appealing options or between two unsuited and normally un-appealing options. He further that either way social workers seem to have to sacrifice something, and social workers’ choice sometimes reduces what Popper (1966) called “minimization of suffering” to the clients.

Mrs. B’s mother is not happy with Mrs. B’s decision to terminate treatment. She called that a bad example for Mrs. B’s son’s future. She holds religious ethical principles that indicate that she believes that all life is sacred, God never gives anyone more than that person can bear, that no one has a right to take another’s life under any circumstances and it is a sin. According to the study case materials, Mrs. B’s mother furthered that Mrs. B is “too young to die”. Her request to the hospital to do not apply Mrs. B’s decision is paying multiple roles, both her spiritual/religious belief and ethical values.

According to Reamer 2001 page 53 NASW code of ethics states that Clients have a right to interrupt or terminate service, also social workers have an ethical obligation and responsibilities to clients who lack decision making capacity. We have noted that Mrs. B is at the end-stage renal disease due to complications of long time juvenile-diabetes and she has been a hem dialysis patient for several years. Mrs. B. has been repeatedly hospitalized, and her irregular depression has become the main concern of family, staff and social workers. This can be taken as confusion on Mrs. B’s part to request social workers to exercise her right of terminating treatment whereby also social workers have an ethical obligation to clients who lack decision making capacity. However, Mrs. B’s mother request to deny Mrs. B’s request is weigh in perfectly for social workers to opt the path of deny Mrs. B’s request and proceed with treatment if they find her incapable of making such decision, or visa-vi.

Another value that has a ole in this case is the spiritual belief of Mrs. B’s mother and Mrs. B’s son as Catholics. Their spiritual belief is weigh in if Mrs. B found legally incapable of make decision to terminate treatment and Mrs. B’s mother re-assume her power as the decision maker named in her daughter's Advance Directive, should Mrs. B. be unable to make decisions herself. As Catholic Mrs. B’s mother claimed that the hospital denies Mrs. B's demand because her depression caused her to be incompetent to make medical decisions. Her case that she is unhappy with Mrs. B’s decision to terminate treatment and called such decision as a bad example for Mrs. B’s son’s future, is an indication of a powerful spiritual value of Mrs. B’s mother and son.

I believe that if I were to be a case worker on this matter, I would opt to render counseling to Mrs. B and evaluate her decision making capacity, while continuing with treatment because I value life. Also NOHSE statement 4 is giving me a reason to treasure my client’s life first because life is precious. Just in case if it was wrongly recorded that the client is capable of making decision of terminating treatment, Mrs. B will be saved and her precious life will be treasured. Also this decision is based on my spiritual belief that life is sacred, and God can do what a human cannot imagine or think that can be possible.

I assume that Mrs. B will be not so happy for this decision but Kenyon page 63, NOHSE statement one state that “Human service professionals negotiate with clients the purpose, goals, and nature of the helping relationship prior to its onset, as well as inform clients of the limitations of the proposed relationship”. Limitation as stated on this statement will be to continuer with her treatment and start counseling as soon as possible. Also I will seek professional help from doctors and see a possibility of anti-depressant prescription  as Kenyon page 63, NOHSE statement four gives me permission to seek consultation where it is necessary.

I believe that the above decision will serve Mrs. B well and family, Mrs. B’s mother and son will be satisfied, and counseling will finally make Mrs. B feel better and different. Today’s science is like centuries ago miracles from God. We have so many invention of treatments. May be miracles of God can play part on this matter. How will it make me as a social worker involved in this case, deciding to go along with Mrs. B’s decision and three months or short period of time after scientist invent treatment of her disease? Put in mind the possibility of her to be alive if she had continued with her treatment. I think our job is to serve the best interest of clients and it is not just to act or making decisions, also to be conscious of the decision we are making and not to implicate the future of our clients.


1.                                                      Kenyon, P. (1999). What would you do? : an ethical case workbook for human service professionals. Pacific Grove, CA: Brooks/Cole Pub.
2.                                                      Reamer, F. G. (2006). Social work values and ethics. New York: Columbia University Press.

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