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Social workers will come across ethical dilemmas on a regular basis. Ethical dilemmas may include inappropriate nature in the workplace, or having to make a decision that may go against protocols but be morally the right thing to do. During internship, interns will face ethical dilemmas as well and must work to figure out how to adhere to the Code of Ethics whilst making the right decision, especially which is in the best interest of a client. Through following the Ethical Decision-Making Process, workers should hopefully be able to decide what to do and hopefully, it will be in the best interest of the client.
In social work, an ethical dilemma is a situation in which two or more of the social work values are in conflict. Ethical dilemmas in social work can involve inappropriate behaviors in the workplace such as violence or inappropriate language, or can involve other aspects such as contacting a client via social media or breaching confidentiality of a client. Social workers deal with ethical dilemmas on a regular basis, and often must consult with the Code of Ethics to make the appropriate decision on what to do.
The recent ethical dilemma presented at Petersburg Department of Social Services involves a little boy whom is part of a case being handled by the department. The dilemma involves the fact that the little boy desperately needs his medication as the medicine is important in regulating his moods and behaviors. His current caregivers are unable to get his medication due to the pharmacy in the area not having the information for the little boy, and social services does not have the authorization to release the child’s information to the pharmacy for his medication. However, again it is stressed that the child desperately needs his medication, but without an authorization form stating that social services can speak to the pharmacy and release his information, the caregivers are unable to get the medication that he has been without for roughly two weeks.
As some background information about how this situation came to be; the little boy is approximately ten years old, and has been involved in a case being handled by social services since his arrival to Virginia roughly a year ago, where he was staying with his biological father and his stepmother. Toward the middle of October, the family had become homeless and began moving from motel to motel. However, towards the end of October, the agency was notified by the little boy’s school that he had been missing from school for an excessive amount of days. After some investigation, workers were informed that the father had been jailed, and the stepmother had suddenly taken the little boy to a friend of his biological mother; this friend being in Chesapeake, Virginia. Roughly a week later, the primary social worker with this family was informed that the little boy was staying with a friend of this person in North Carolina, and that the little boy had been initially dropped off in Chesapeake with just the clothes on his back – no extra clothes, or the most important aspect: his medicine. This prompted the current caretakers – a couple in North Carolina – to call the agency to figure out what steps could be taken to get the little boy his medication that he desperately needed. However, the agency did not have authorization to release the child’s information to another pharmacy in another place, and so the ethical dilemma came into play.
From reading through the NASW Code of Ethics, this situation conflicts with privacy and confidentiality. As a brief overview, the privacy and confidentiality section of the Code of Ethics highlights that social workers are meant to respect the privacy of all clients and keep information confidential, unless in compelling professional circumstances. For this case, the first two parts of this section stuck out the most. Of the Privacy and Confidentiality section, part A highlights that “Social workers should respect clients’ right to privacy. Social workers should not solicit private information from or about clients except for compelling professional reasons. Once private information is shared, standards of confidentiality apply” (Code of Ethics: English, 2017). Part B highlights that “Social workers may disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client” (Code of Ethics: English, 2017).
Who will be affected by the decision? What options are there?
When considering who will be affected, one must look at all sides of the equation and explore all options. Ultimately – no matter the decision – the client will be affected as it is his life that the ethical dilemma revolves around. If the worker were to make a wrong decision or resolve this dilemma in a manner that was wrong, then the worker, or the agency, could be negatively affected. The parents of the client could be affected as well, depending on the decision being made in resolving this dilemma.
There are a few courses of action that the worker could take in resolving this dilemma as well. For one, an option would be to request to speak with his father in the jail where he currently is located, and to have his father sign the authorization form with a new option which would authorize the workers to release the client’s information to the new pharmacy. Another option would be to have his current caretaker try and petition for custody over him, which would hopefully allow for the caretaker to have the information. A final option would involve the worker speaking with a supervisor to see if there is any way to release the information to the pharmacy without the authorization being resigned, as the client really does need his medication for his behaviors.
There are several aspects to consider when weighting the options of how to go about solving this dilemma. The first option would be for the worker to speak with a supervisor, to see if there is a way that the authorization can be “bypassed” in a sense, allowing the child to get the medication without an authorization. An advantage to this option would be that the client would finally be able to get the medicine he needs, and another advantage is that there would not be a need for time consuming activities such as waiting for custody or finding the father to resign the authorization. However, there are a few disadvantages to this option as well. For one, if the worker was to speak to the pharmacy and release information despite having gotten verbal permission from a supervisor, if there is no written documentation then there could be consequences. Another disadvantage is that, again, the information could fall into the wrong hands, which could jeopardize the confidentiality and privacy of the client.
Another option would be to try to obtain a new authorization from the father of our client, which would allow the agency to speak to the pharmacy on behalf of the client. A couple advantages to this idea would be that the agency would then have permission to release information to the pharmacy in the area where the client is located, which would allow for him to receive the medicine he needs. Another advantage would be that if the agency should run into this issue again in the future, the agency would have reauthorized paperwork for future reference. The disadvantages to this however would be that this could possibly allow for the pharmacy to have too much access too client information and to know too much about the client, which could be dangerous if information were to fall into the wrong hands.
A third and final option would be to have the current caretaker petition for custody of the client. An advantage to this would be the fact that the client would then have right to the client’s information which could help to get his medicine. Another advantage would be that the client would then get his medication that he needs. However, there are also disadvantages to this situation. A disadvantage in this situation could mirror that of the first option; if the information were to fall into the wrong hands, there could be a dangerous situation. In addition, if the caretaker were to petition for custody and ultimately win, the agency would no longer have ties to our client due to him being in the custody of someone, which may not be good considering the child still needs services provided by the agency.
If I was the worker in this situation, I would follow the process of making an ethical decision. To begin, I would recognize the problem in my head and ask myself what options to consider. In this case, the problem is that a client needs his medication to regulate his mood and behaviors, but we cannot release his information to another pharmacy without an authorization farm stating that we can speak to that agency on his behalf. After recognizing the problem, I would weigh my options – as done above when considering what route to go down in resolving this ethical dilemma. I would then continue to consider the Code of Ethics and follow the rest of the ethical decision-making model.
Personally, if I was handling this dilemma and wanted to address it, I would try each option – if need be. For example, I would first speak with a supervisor to find out if there is any way to simply gain permission to speak to the pharmacy to get the medication for our client; perhaps such as an emergency order which would allow myself and workers to speak to the pharmacy to get the medication without written authorization from the father. Our hope would be for this to work with only permission from a supervisor. While there are risks involved, this would be the quickest option to get the medication.
If the first option did not work, I would then attempt to gain a reauthorization from the father allowing myself and workers to speak to the new pharmacy on behalf of the son to get the medication. In this case, as stated above, the father would simply resign an authorization form but with authorization for us to speak to the new pharmacy on behalf of his son, for the caretaker to get his medication. If this did not work, we would then look at the third and final option, which would be to see if the current caretaker could petition for custody of the child and in that way, be able to get his medication.
Social workers will face ethical dilemmas on a regular basis, from all areas of work whether it be between coworkers or having to decide on how to handle a situation with a client. The Ethical Decision-Making Process is an important tool to use; perhaps not in a written way, but it is something to consider when thinking about how to solve an ethical dilemma. In the end, either the clients will benefit from the decision, or in the worst case, the agency may face consequences of a decision as well. However, social workers must always remember their dedication to the clients, and hope that the decisions will be beneficial to the client without harming anyone in the process.
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