Professional social workers are regularly confronted with ethical issues and dilemmas in practice. Hugman & Smith (1995), explain that ethical issues and dilemmas arise when the social worker and clients differ in their perception of what is right or wrong. Ethics can be defined as the 'rightness' of a situation and therefore Ethical issue occurs when a subject has both features of right and wrong. On the other hand, ethical Dilemma arises when health care workers or social workers are faced with two or many options of choice (Banks, 2012). It is also a misunderstanding of matter based on ethics or inadequate of it. In the case study, a 58-year-old homeless man has been taken to the casualty department of the local hospital in the middle of winter. Paul Desmond suffers from gangrene in the toes of one of his feet. It is the responsibility of social workers to analyze the ethical dilemmas and issues in the situation and provide help using the ethical principles.
There are several dilemmas in Desmond case that the social worker has to analyze and determine possible solutions on how to solve them. Desmond is a sick, but he refuses to accept treatment because he would lose his three toes. He is suffering from gangrene in the toes of one of his feet. He refuses the treatment because he would be an "incomplete human being". The treatment that the doctors recommend to him involves amputating three toes from his foot. In this situation the social worker would to make decision between following Desmond suggestion or administer the medication because there is no other option to his treatment. The social worker would decide whether to administer the treatment and make Desmond an incomplete man or leave him to die from the disease. The healthcare providers are certain that if medication is delayed, Desmond would die. It is their responsibility to prevent loss of lives in hospital that can be avoided. Desmond life can be saved if the right medication of amputating his three toes is administered but he refuses to accept the treatment. It is unethical for healthcare workers to force medication to an individual that causes harm or injury . Amputating three toes from his foot is a permanent injury because he would leave without them for the rest of his life. The doctors are not supposed to perform surgery on a patient without his consent. Desmond does not accept the surgery and this delays his treatment and increases the likelihood that he would die soon. Another dilemma is whether the social worker should notify Desmond's brother about his condition. The hospital records have Paul brother's phone number and when the nurses asked Desmond whether they should call him and explain the situation to him, he responds angrily that he does not want to see him because they do not relate well. The social worker believes that Desmond's brother would talk sense into him, and persuade him to accept the treatment. However, the social worker is not certain how Desmond would react when he sees his brother since they have not had any contact for over five years. What if Desmond refuses to cooperate when the social worker involves his brother against his will? The social worker would have to analyze the two incidents before he calls his brother. The last dilemma is on Desmond argument of becoming an incomplete person once his three toes are amputated from his foot. Records show that he has a history of mental illness and this might be the reason why he interprets the treatment as harm to his body. He does not see the sense that he would die soon once the treatment is delayed because he does not reason logically. The social worker has to analyze his mental health and decide whether he can make a logical reasoning.
Ethical theories and how they help to explain the perspectives of the participants and the dilemmas they face.
Utilitarianism ethical theory
Utilitarianism is a normative ethical theory that determines locus of right and wrong solely on the outcomes (consequences) of choosing one action/policy over other actions/policies (Broad, 2014). It therefore shifts from one's interests to those of others. According to this theory, the most ethical option is the one that produces maximum results. It questions is an action is moral or immoral, good or bad depending on its outcomes. It is an economic analysis and concentrates on human happiness in life. It therefore argues that if an action makes people happy, it is good. In Desmond's case study Desmond believes that if he accept the treatment the doctors are suggesting, he would lose his three toes and become unhappy if life. As a result, he chooses to be happy in the few days he would life and die as a complete man. He uses the Utilitarianism theory to compare between the two options and chooses to die as a complete man because it makes him happy Broad, 2014). To Desmond, dying a complete man is the right action. The doctors know that if they do offer treatment to Desmond he would die. Administering treatment to him yields more happiness than letting him to suffer to death. The doctors perceive that the right action is to give medication to Desmond. The nurse perceives that the right action would be to call Desmond's brother because he would talk sense to him, and convenience him to accept the medication.
Duty theories make human beings feel obligated to care for others. The duties under these theories are classified into duties to God, duties to self, and duty to others. It is the duty of human beings to know the existence and nature of God (Broad, 2014). Duties to oneself include improving one's skills and talents that develop one's soul. It also includes body protection by not harming or causing injuries to the bodies. Duties towards include treating others equally as one would wish to be treated in the same situation. Promoting good of others and avoiding any action that would wrong them (Broad, 2014).
Deontological ethical theory
Deontology theory focuses on the perception of duty instead of emphasizing the concept of good or wrong. It was developed by Kant and it stresses on the type of action instead of outcomes that action. The theory states that actions or decisions depend on one duty and right of others. The social workers and healthcare providers should behave concerning the results and should base the action on its moral if it is being carried out for duty's sake. The theory argues that believes that the results of an action do not matter because all situations do not turn as individuals want (Alexander& Moore, 2007). People can only control their motives by doing what is right because their morals guide their decisions. Using deontology theory to explain the perceptive of the participants involved it can be analyzed that the doctors will save Desmond by amputating his three toes from his foot because it not morally right to allow him to die just because he does not accept the medication. Moreover, according to deontologist allowing the man to die would not make that decision justify. However, according to deontological theory allowing the Desmond to die would not make that decision justify (Alexander & Moore, 2007). The social worker would go against the Desmond's will, and explain the situation to his brother because of it morally right to do so. Moreover, it is the duty of the social worker to undertake all actions that would convenience Desmond to accept the treatment and save his life.
How relevant ethical theories and professional values can help to resolve the issues form a professional social work perspective.
When handling ethics issues and dilemmas social worker employs the concepts that relate to utility, consequences, duty, and results. These concepts are utilized by the utilitarianism and deontological ethical theories. To resolve the ethical dilemmas in Desmond's case utilitarianism theory can be used. Using this approach Desmond toes should be amputated because it would not bring him maximum outcomes (Osmo & Landau, 2006). He feels that if his toes are amputated he would be an incomplete man, but this action would result in greatest results because he would live. Utilitarianism is a moral approach that argues that the morally right option results in maximum outcome over harms for everyone affected. So long as option produces maximum outcomes for everyone, utilitarianism does not care whether the benefits are produced by manipulation, lies, or coercion. The doctors can, therefore, go ahead and amputate Desmond's toes to save his life. The social worker should also involve his brother because this action leads to maximum benefits since his brother would manage to convenience him to accept the medication and also accommodate him. Using Deontology theory the issue would be resolved by everyone performing according to his/her duties. The doctors have a duty of protecting live even if it's an insane man involved. In this approach, the healthcare providers and social worker should take the action of administering treatment Desmond because it is the morally right action (Osmo & Landau, 2006).
There are three professional values that social workers possess to help them deal with the dilemmas. Human rights of everyone should be respected regardless of their mental status. Everyone has a right to life which should be protected at all costs. The decision should promote Social justice. In this case, saving Desmond's life is a social justice action.
Professional social workers uphold integrity by being reliable and trustworthy in resolving the issue so that the client would believe in his/her expertise.
What do you think the social worker should do.
The social worker should talk to Desmond and listen to his perspective. The social worker should identify reasons that make him refuse the treatment despite the fact that he would die. The social worker should analyze his arguments and examine whether they are logic or not. To build a close relationship the social worker should accept his wishes and convince him to meet with his brother who would convince him that there are immediate risks to his life if he is not treated soon. The social worker should ensure that they do not use threats or manipulation to convince him to accept the medication unless all other methods fail. The worker should ensure that Desmond accepts the medication voluntarily (Saleebey, 2012). The social worker should explain to Desmond that the treatment only involves three toes and not the whole le and therefore he would still be able to walk normally. The social worker should explain that he would not be incomplete because he would be healthy. The social worker should involve Desmond's brother in the process because he would listen and obey him.
Your own personal ethical perspectives and values relating to the case study and the influences on their development.
I value human life because it is sacred and should be protected by all means. I, therefore, believe that the social worker has a significant role to play in the decision making of Desmond case. The social worker should convince Desmond to accept the medication by explaining that he would not be incomplete. Besides he would more complete that he is because he would be free from his illness. I have good role models, scout leaders, teachers, and grandparents who have supported me in the development of a sense of right and wrong, and but also to question right and wrong options in every situation (Saleebey, 2012). I treat everyone with dignity and this helps me to respect Desmond and his perceptions despite the fact that they are not logically reasoned. I know that Desmond has mental disorders which would be the reasons why he chooses to die than to be treated but am patient with him and want him to understand the value of his life (Banks, 2004).
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