Question of Power

[Anonymous]

Please note: all names have been changed
The Canadian National Institute for the Blind (CNIB) provides services and supports that maximize a person’s ability to be independent despite vision loss. Orientation and mobility is one of the services that is offered to help people stay active by themselves inside and outside their home. For example, people are taught routes to the grocery store, the pharmacy, and the laundry room if it is outside their unit.
Tanya, the Orientation and mobility specialist, has her services requested for a new client. When she is reviewing the client, Emily’s case, she sees the client has early onset Alzheimer’s. Although Emily is only 50, she is requesting orientation and mobility services to help her use bus routes, and longer walking routes, as she lives outside of the city.
Before Tanya meets Emily, she struggles with the ethical dilemma of limiting Emily’s mobility to a smaller scope by not teaching her the bus routes and only showing her routes to closer attractions from her home. Tanya is worried that because of her Alzheimer’s diagnosis, Emily will unsafely use the bus. Tanya is concerned that Emily’s orientation will become compromised and the confusion Tanya assumes Emily feels may make her susceptible to getting easily lost.
Thus, Tanya must decide based on the client’s profile what routes she is interested in taking and how to tell Emily that she is unfit to learn other routes, despite CNIB’s mandate of keeping client’s as independent as possible.

[Anonymous]

The Canadian National Institute for the Blind (CNBI) mandate is to provide services and supports that maximize a person’s ability to be independent despite vision loss. I understand that Emily’s early onset Alzheimer’s may complicate the decision on whether she can receive those services based on when it comes to the safety and well-being. However, untimely I believe that it is Emily’s choice to make. I assume that Emily knows she has early onset Alzheimer’s, but may not know what all that entails. To minimize a power imbalance Tanya should have a conversation with Emily. It may be beneficial for Tanya to have a conversation with Emily and voice her concerns on the possible confusion and susceptible to getting easily lost, due to Alzheimer’s. I believe that the language used in this conversation will also have an impact, for example, replacing the word “unfit” for something more friendly, and providing options and resources. For example, as stated above, mobility is one of the services that is offered to help people stay active by themselves inside and outside their home. If providing services such as aiding in the usage of bus routes, and longer walking routes is an ethical dilemma, then maybe providing services that are inside their home.

[Anonymous]

This is a really good ethical question. I feel it could be useful in this case is questions what CNBI states for the definition of independence. Does that definition come directly from Tanya, Emily, or a combination of the two? Tanya has an ethical obligation to protect the safety of her client. In saying so, I do not believe she should use that to make choices for her client that ultimately affect their life. I feel Tanya should make the decisions about transportation and mobility with her client. Having the conversation about what Emily wants in regards to the risk of having early onset alzheimer’s and what independence means to her. During that conversation, Tanya should keep her ethical obligations of safety and follow her agency’s mandate in check.

I think this example is transferable to many areas of social work practice. As a social worker we need to follow our ethical guidelines set for us by our registry bodies, but also follow our mandates of the agencies we work for. I feel there is a balancing act we sometimes have to do. This is happening in this case. Until it comes a point where Emily cannot make decisions about herself, the decisions that will directly impact the life of the client should be a mutual decision.

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