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  • in reply to: Ethics in Relation to Friends #236

    This one is a tough one for me, so much to consider and think about!

    1. How would you deal with this situation when taking into consideration client confidentiality?

    This case is really about the clashing between client confidentiality and ethical responsibilities. On one hand, the client does not wish for this information to be used negatively in any way – however, you have a responsibility to report this information to your boss because it violates ethical practice.

    I believe this is one of the exceptions to client-worker confidentiality. At the end of the day, you cannot be having sexual relationships with clients and must report this information. I do not really like that this is true, but I would end up reporting it.

    Perhaps the worst part of this case is how the trust will be completely gone between you and Bill and will likely never trust you again. This could negatively impact his life and complicate his future relationship with social workers, which is a terrible aspect of our system.

    2. How would you deal with this situation while keeping in mind that it is your own friend that is being accused of having had a sexual relationship with your client?

    I would feel empathetic towards my friend in this situation. Since they engaged in this relationship, they must’ve known this may happen, and I would hope they would not be angry with me for reporting them. I really wish my boss would give them a second chance, because mistakes are made by all. As social workers, we tell our clients that we are not super heroes and that we cannot fix their problems for them – but this is easier said than done. We look at our colleagues as super heroes that should know better and be perfect in every sense of the job, given the intense and private nature of the work. We do not forgive each other like we do our clients, because the reality is we are held to a different standard by each other. I think this is because we live in a largely fear based society – if I don’t tell, I could lose MY job, the organization could get shut down, everyone could lose their career.. All valid concerns – but instead of that, why not consider: What if we gave each other a second chance?

    3. Does the fact that this is no longer occurring change what you would want to do about it?

    Absolutely! My friend and colleague did the ethical thing and ended it. This should count for something, since by ending it they must’ve acknowledged that it was wrong in some way, and probably feels much shame for this. As previously stated, I wish there was a way for all parties to come back for this. Perhaps a internal ethical policy, where some situations can be dealt with in a way that doesn’t involve your friend getting fired, especially if this was a one time mistake. That is not to say that people who make repeated (perceived) mistakes deserve punishment, more or less something to keep thinking about!

    4. Does this client’s addiction influence the stance you would want to take -given that there could be questions of his credibility?

    This was perhaps the most simple answer – no. Not everyone lies when using substances, and what the client says should be taken seriously regardless.

    5. How if at all does being a casual worker change what you would want to do or feel you could do?

    It can be quite intimidating being a casual worker in this situation. Chances are your co workers don’t know you as well, perhaps not as well as they know your friend, and could look at you as the reason their friend was fired/punished. Your boss could also not take what you say seriously, and run the risk of jeopardizing your job and career. If this is the first time you have approached your boss with a situation like this, you might not know how to handle it. You are likely not seeing them everyday and have not had a chance to form a work bond, and a situation like this could definitely affect how they view you – whether positively or negatively, depending on how you handle the situation.

    in reply to: Case of Non-Disclosure #235

    This case is incredibly complex and multi-layered. This reminds me of what we discussed in class today regarding deciding who your client is. In this situation, is the client the patient? Or the patients family? Or is the patient and their family, collectively? I believe the patient is our client, and not there family. However, this sparked some interesting inner dialogue.

    This reminds me of a personal situation I went through two years ago with my grandmother. At that time she was 92, and was rushed to hospital because of a blood clot in her lungs and heart (pulmonary embolism). The doctors said she was too old to undergo heart surgery, and if the blood thinning medication didn’t work to dissolve the clot, it would only be a matter of time. These situations are similar because in both cases the client was presented with an end of life decision. My grandmother was aware of her situation, and this fictitious client was not. However, even though my grandmother was aware of her situation, she turned to her children and told them that it was their decision, and that she could not make it. They felt a responsibility to honor her wishes to let them decide – she had already lost 4 our of her 8 children. With this experience, I could understand why the family was making the decision.

    However, I believe from an ethical standpoint, the health professionals and family have no right to with-hold information about an individuals health. This seems intensely unfair to the autonomy of the patient, as someone deserves to know when they have final stage (seemingly uncurable) cancer. My grandmother was informed of her situation and made a decision herself – maybe not the one people would want her to make, but one none the less. I am happy to report that the medication worked and my grandmother is still being a rockstar at 94.

    There could be cultural reasons for the family making the decision – perhaps they are located in a collective world view where families make these kinds of decisions. This is definitely a possibility that we cannot rule out as practitioners.

    I believe my first step would be to approach the doctor in charge and express my concerns about the patient not knowing their diagnosis, and how it is a violation of privacy, autonomy, and I’m sure breaks many hospital regulations (although I realize these rules are broken all the time, and situations like these are sadly common). Hopefully they would understand the concern and act accordingly.

    This is a tough situation that I will definitely be thinking more about in the future!

    Forbes MacQuarrie

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