Social Work Theory 120 Chapter 6 PDF

SOCIAL WORK THEORY 120 Chapter 6- Ethical Principles in Practice Mayuri Ranchhod Understanding Autonomy: Maximising Liberty and Agency bioethics, or the ‘ethics of life’ refer to ethics in the healthcare field where a primary principle is r...

SOCIAL WORK THEORY 120 Chapter 6- Ethical Principles in Practice Mayuri Ranchhod Understanding Autonomy: Maximising Liberty and Agency bioethics, or the ‘ethics of life’ refer to ethics in the healthcare field where a primary principle is respect for autonomy Having its roots in liberal Western traditions of individual freedom and choice, autonomy preferences the notion that moral and ethical behaviour must involve the individual’s own choice over their action The concept of autonomy implies self-rule that is free from both controlling interference by others and from limitations, such as inadequate understanding, that prevent meaningful choice The autonomous individual acts freely in accordance with a self-chosen plan One of the prerequisites for autonomy is that a person must have rationality, which is the capacity to act intentionally and to reason through the consequences of actions In the social, health and human services, the term ‘self-determination’ is more often used to denote the requirement for clients to determine their own choices Two conditions must be satisfied for autonomy or self-determination to be possible: liberty and agency o Liberty involves independence from controlling influences while agency refers to the capacity of the client for intentional action Critiques of autonomy and self-determination cite the philosophically dominant Western context in which they have been developed, which clearly prioritises the rights of the individual over the collective autonomy from our professional position is about respecting clients’ right to make choices about issues that affect their lives Autonomy comes with some restrictions, however, in that the making of choices cannot harm self or others, and needs to be within acceptable societal standards One of the highest forms of punishment for wrongdoing is the taking of someone else’s life (capital punishment), followed by constraining someone’s freedom through imprisonment Self-Determination in Practice: Questions of Capacity Decision-making capacity is the patient’s ability to make choices that reflect an understanding and appreciation of the nature and consequences of one’s actions and of alternative actions, and to evaluate them in relation to a person’s preferences and priorities Agency has the potential to become extremely complex in practice, as there may be many situations where questions regarding a client’s capacity for self-determination arise To be competent to make decisions, an individual must be able to understand the relevant consequences of that choice, both on themselves and on others  The codes of ethics of the helping professions provide guidance that promotion of autonomy is desirable, however detailed guidance on how to determine agency and competency is more complex Competency is also subject to change, depending on certain factors. Take, for example, an elderly woman who is admitted to a medical ward confused, irritable and unable to give details of her financial affairs Paternalism: Moral Offensiveness or Justifiable Action? Paternalism refers to acting without someone’s consent or overriding their wishes, wants or actions, in order to benefit them, or at least protect them from harm Paternalism can be either ‘weak’ or ‘strong’ o Weak paternalism refers to a situation where we might override the wishes of a non-competent person with a view to restoring the person to competence, whereas strong paternalism overrides the wishes of a competent person Guillemin and Gillam describe paternalism as one of the most common ethical issues in health care, and have said that: ‘paternalism involves putting a higher ethical priority on doing good for patients and protecting them from harm, rather than respecting their autonomy’ Informed Consent: A Legal Obligation The process of ensuring that a client’s right to autonomy is met prior to any intervention is referred to as informed consent healthcare professionals (most notably doctors) were not required to gain consent from patients and it was not unusual practice to conceal information from patients if it was determined by the healthcare professional that this would be in the best interests of the patient  The ability to demonstrate that a client gave his or her consent for an intervention provides some protection should that intervention come into question at some point in the future. Informed consent is essentially the process whereby professionals gain autonomous authorisation from the client to proceed with planned interventions Garrett, Baillie and Garrett outline two conditions that must be present for informed consent to be lawful: o 1 The patient must be competent and able to understand consequences of the consent, so that there is no undue coercion to consent (voluntariness). o 2 All necessary information must be provided to allow the patient to give fully informed consent. Establishing informed consent must therefore involve both an information component and a consent component and it must be given voluntarily Practitioners must discuss with clients their rights and responsibilities and provide them with accurate information that outlines: o the service being offered o who will have access to recorded information about them o the purpose, nature, extent and known implications of the options open to them o the potential risks and benefits involved in the course of action o their rights to obtain second opinions o their avenues of complaint. Informed Consent in Practice The procedures that we will be required to follow to demonstrate that informed consent has been gained will vary depending on the employing organisation, the client group and our own preferred working style Consent forms for medical treatments are generally straightforward, outlining the procedures offered, the risks and benefits to the patient and the complaints procedures that patients can follow should they wish to do so informed consent forms used by psychologists, social workers and welfare workers are often more detailed, providing information on the agency offering the service and the qualifications and experience of the professional delivering the service It is now common practice for informed consent documents to be written in a number of languages, and best practice dictates that verbal processes of explanation accompany completion of documents Working with involuntary clients requires that we are knowledgeable of the legal and professional requirements concerning informed consent with our client groups. Privacy and Confidentiality: Defining ‘The Right to Know’ Although many social, health and human service practitioners have long been concerned with protecting clients’ rights to privacy and confidentially, formal documentation of these rights is most often associated with the development of professional codes of ethics and practice standards in the second half of the 20th century The social, health and human services have undergone much change in recent decades due to advances in technology While the risks involved in protecting clients’ information that exists in hard copy are considerable, the growth in online mediums for service delivery has brought with it a new range of concerns regarding the safeguarding of client information As service delivery contexts continue to change, so too must our vigilance in keeping abreast of systems that are able to deliver on the rights of clients to privacy and confidentiality Privacy and Confidentiality: Is There a Difference? Privacy is concerned with being in control of the access that others have to personal information and the capacity to protect oneself from unwelcome intrusion Privacy has been situated as one of the human rights that people should be afforded Confidentiality concerns the treatment of identifiable, private information that has been disclosed to others, usually in a relationship of trust and with the expectation that it will not be divulged except in ways that have been previously agreed on Privacy is the foundation for relationships in the helping professions, and particularly in the therapeutic relationship Without the right to privacy, many clients would be reticent to consent to sharing personal aspects of themselves As a general summary, the codes of ethics of social, health and human service professions provide information on what is meant by privacy and guidance on how to achieve it In a general summary, they include: o the requirement not to share client confidences, clarifying in which situations this may be overridden, such as legal prerogative or duty of care considerations  o the need to disclose client confidences, if required, in such a way that a client’s rights to privacy are respected o the requirement to exercise caution when keeping client records, to ensure that a client’s privacy is privileged. Privacy in Practice Although inclusion of the points relating to privacy in the various ethical codes clearly evidences the importance of practitioners giving due consideration to the client’s right to privacy, there is agreement in the literature that the contemporary complexities of delivering on the above points are significant privacy may be complicated by the need to collaborate with colleagues, by high staff turnover, by the requirements of the bureaucracy and the law and by the keeping of required records Confidentiality and its Limits the notion of professional confidentiality implies four principles: 1 Information is not limited to that actually communicated by the client to the professional – it can include opinion derived from observation as well as the exercise of professional judgement 2 The duration of the obligation extends beyond the period when a person has ceased to be a client 3 The obligation can be overridden in some circumstances by other ethical considerations 4 The obligation is subject to compliance with the law, at least when the specific law in question is ethically defensible. All professional codes of ethics in the social, health and human services promote the client’s right to confidentiality and provide guidance on how to meet this requirement in practice In summary, professional codes of ethics require that we ensure that clients o consent to the use of their private information prior to such information being divulged o know to whom their information shall be given and in what detail o know from whom information about themselves may be requested o are fully informed of their right to confidentiality and the limits of confidentiality, from the start of the professional relationship Additionally, codes of ethics typically provide detailed guidelines on when it is appropriate to breach confidentiality and what procedures must be followed if this becomes necessary These circumstances may include disclosure of client information, if and when there is: o a legal or ethical obligation to do so  o an immediate and specified risk of harm to an identifiable person or persons that can be averted only by disclosing the information If a decision is made to break confidentiality and report suspected abuse or potential harm, this should be done in a way that respects the dignity of the client, regardless of what they have done or threatened to do Suggestions on a process to follow to ensure respectful treatment of the client include: o involving the client in reporting the incident o discussing with the client why a report needs to be made, what the benefits and risks are to the client of making a report, what procedures will be followed once the report is made and what some possible outcomes might be o inviting the client to ask any questions they may have o ensuring the client has support throughout the process Challenges to Upholding Privacy and Confidentiality the contemporary understanding of privacy and confidentiality in the social, health and human services is largely informed by Western notions of the importance of prioritising the individual over the collective When working with Indigenous clients or those from non-Western cultural contexts, it is particularly important to be sensitive to alternative worldviews that place a higher priority on the family or community as a whole In this circumstance, family members may not understand why we cannot share information with them about their relative, and they may believe that our withholding of such information is inappropriate when working with clients from different cultural backgrounds, it is desirable to work closely with colleagues from that culture to determine the most appropriate method of communicating the professional requirements with regards to confidentiality and privacy Working with couples or groups presents another challenge in relation to confidentiality and privacy o it is especially important to inform all parties of what information will and will not be shared To ensure that a client’s rights to confidentiality are respected when conducting group work, we need to spend a reasonable length of time at the beginning of the process, and at the start of each subsequent session, outlining the procedures for ensuring the confidentiality of all participants It is important that practitioners who facilitate groups understand the limits of their responsibilities o All the discussions in the world about the need for respect for people’s privacy in a group context will not stop some people from inappropriately divulging outside the group personal information that belongs to others  A further area of practice that can provide for significant challenges in relation to this issue occurs in rural practice settings Complexities arise in rural practice when, for example: o practitioners in the community hold dual and multiple roles, such as acting both as a member of a community safety committee and a volunteer suicide- prevention counsellor Possible solutions can include being clear and consistent regarding boundaries, strictly following agency procedures, ensuring that clients are only acknowledged in public with their prior agreement, and locating services in another town if clients would prefer Online Platforms: The Challenge to Privacy and Confidentiality Privacy and confidentiality protocols in the social, health and human services have struggled to keep up with changes in technology, attempting to use the online environment to streamline service delivery while seeking to ensure that client information is protected organisations need explicit procedures and protocols determining the appropriate use of computer records and client data The Duty of Care The duty of care is a legal obligation imposed on an individual and that requires that they adhere to a reasonable standard of care when engaged in the performance of actions that could potentially harm another Enshrining the duty of care in law is essentially a formalisation of the social contract that exists between individuals involved in some form of relationship or action In order to prove negligence, it must be established that the duty of care has been breached Establishing limits on who has a duty of care and under what circumstances it can be said to have been breached has been an ongoing legal debate three criteria were established to determine if duty of care has been breached: o harm must be a ‘reasonably foreseeable’ result of the defendant’s conduct o there is a relationship of ‘proximity’ between the defendant and the claimant o it must be ‘fair, just and reasonable’ to impose liability. the phrase ‘duty of care’ is at best too vague, and, at worst, ethically dangerous The nature and scope of the duty need to be determined, and conflicting duties must be recognised and acknowledged Duty of care is neither fixed nor absolute but heavily dependent on context Codes of ethics tend to use phrases that are open to interpretation, such as ‘reasonable care’, ‘reasonably foresee’ and ‘reasonable person’ The Duty to Warn and Protect from Harm concerns the requirement to report information that indicates that there is a likelihood of harm occurring to a person or persons Determining when to warn clients of duty to warn obligations provides us with considerable ethical discomfort, as we saw in the discussion about forewarning, as to do so may break established confidences In deciding on the most appropriate course of action, we can seek guidance from a range of sources, including: o the law o our professional codes of ethics o the requirements of our employer organisation o our own ‘practice wisdom’ (that is, knowledge built up over time from our experience – our intrinsic knowing of what works and what doesn’t) Documentation and Client Records: Collaborative Information Sharing The codes of ethics of the social, health and human services provide guidance on how to record information so that we respect the client’s right to confidentiality  This includes ensuring that we: o only record essential information o share records appropriately, with prior client consent for sharing of information that relates to them o store client records in a safe location for the required period (this is sometimes determined by law) o destroy both electronic and paper records appropriately when required Even more important is the right that clients have to access information written about them, which means that care has to be taken to ensure that written records are accurate, respectful and focused on the purpose for which they have been written Documentation and writing in professional practice can take many forms o critical incident recording o intake summaries o case notes and case records o action sheets o specified court reports