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ngozi.otti

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  • in reply to: Case of Non-Disclosure #238
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    ngozi.otti
    Participant

    This is a very hard situation especially as a social worker whose commitment is to the individual client as defined in a North American neoliberal environment that sees patients as isolated individuals from their families. However, in this case, it would be important to know that the client is not only the patient but Elizabeth’s client has now expanded to include the family. Seeing the family as also a client would help see opportunities to discuss the implications of their decision, to understand the reason for their decisions and to explore cases where families have told patients the truth about their health status and working together.
    Also, I will discuss this issue with the organization since the decision is being supported by the organization. The organizational values and commitment to honesty and integrity of service is what is at stake here. If these practices are reflected in the organizational values and I have agreed to work with this organization, I will play by their rule while acknowledging these practices are unethical.

    in reply to: In whose best interest? #237
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    ngozi.otti
    Participant

    Thank you for posting this case. It is really thought-provoking and a challenging situation. I respect Irene’s struggle for independence and self-determination.
    1. However, finding the right balance is not an easy fix especially in a neoliberal environment that promotes individualism over collective forms of association and community living. As a potential social worker, I think that self-determination is a coping strategy that results in a society where individuals are left alone to care and support themselves even during times of ill-health. Therefore, finding the right balance for Irene’s self-determination and greater community safety would require a structural approach that would examine how society’s values, practices, structures and systems of organization produce escalating factors that creates feelings of vulnerability for persons such as Irene. Therefore, there is need to establish a community support group where Irene would have the space to assert herself, share her strengths and experiences and feel valued and supported by persons who have similar experiences. Through the community group, persons such as Irene could identify their felt-needs such as safety, trust and work collectively to meet those needs and even take collective action to to change practices or services that have proven ineffective at the organizational level. It will also be important to help Irene understand how important and meaningful her life and well-being is for the overall interdependent well-being of others. Not to make her feel that her life and living is solely her responsibility. Family involvement or the involvement of those she loves would be vital. Taking time to explore the relationships in her life eg children, spouses, parents, friends, community etc would provide insights into her strengths, skills and abilities. Having been through rough times and struggling for self-determination, a strength-based perspective presents potential opportunities for persons like Irene.

    2. Is it paternalistic to believe that it is potentially dangerous for this client to return to the community, especially without any formal supports in place? How can one come to terms with feeling this way?
    I think it would be paternalistic to feel that it is potentially dangerous for Irene to return to her community. First, there is no community in this case rather what Irene has to return to is a house with probably no one, no friend and to emptiness; to a neighborhood that stigmatize her as a person with mental health. The feeling that Irene would be potentially dangerous to her community stems from the social worker’s unconscious fear of harm and need for self-protection and the protection of individual rights and properties. These are neoliberal values. The question is whose interest are we protecting? It would be important for us as social worker to critically reflect on our feelings, their sources and factors that drive these feelings especially in order to guard against transferences that may potentially influence our judgments. If Irene wants to go back to her home, I will explore this need with Irene, work with her to establish a community support team, and develop a transition plan that will give time to monitor her over a period of time.

    3. What ethical dilemmas do the resource constraints add to this case?

    The issue of resource availability is obviously an important one. The allocation and use of resources are driven by values that we find important in the society. Persons such as Irene needs to spend more time in the hospital or shelter while working on a transition plan but with neoliberal cut-backs on health and socially-related issues, keeping persons like Irene in the hospital for longer periods would be unwelcome. The dilemma between keeping Irene longer in the hospital and serving persons in emergency situation is a decision.

    4. With whom might you advocate around your concerns?
    I will advocate to my supervisor and higher managers and those involved in the care and treatment of Irene to approve a transition plan that would be based on an inter-professional approach and the development of a support group for those in similar situation like Irene.

    5. How would you go about advocating and what would the nature of that advocacy be?
    I will work with Irene as a partner to discuss and develop a transition plan, identify others who are in similar situation to form a support group. Identify actions that needs to be taken by Irene and by others. Use the transition plan as our advocacy document to be presented for brainstorming, review and suggestions by supervisors, managers and colleagues

    6. What would you do in this situation?
    Like I mentioned earlier, I will work with Irene in a every step, develop a trusting relationship where she will see me as a partner rather than a social worker trying to fix her.

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