Case Study
Danny, a 23 year old man was diagnosed with a debilitating illness at the age
of 16. His condition has deteriorated and he is now dependant on others to have
all his needs met. Prior to his diagnosis he had always been an active young man
with a promising football career having been picked for the Hull City Youth
Team.
Danny is unable to mobilise independently, has congestive heart failure, regular
chest infections and is in constant pain. He lives in supported housing and uses
Direct Payments to employ personal assistants to support him.
Danny's brother, Colin, also supports Danny with the shopping and social
activities. Recently, Colin had purchased a personal computer for Danny, which
has given him the opportunity to access the outside world in an enabling way. He
has started doing his own grocery shopping online, has been looking at college
courses and has even widened his network of friends through chat rooms.
As a student you attend a review with his social worker. It comes to light that
the Warden of the supported housing complex has advised Colin that Danny had
been accessing gay sites. This has resulted in Colin taking Danny's computer
away.
(1) Explain what values and ethics are and their importance in
relation to the scenario. (This section requires you to explain the
impact of values and ethics in relation to the scenario.)
Values and ethics are fundamental issues in social work
practice; issues that affect the social worker in every decision and
interaction with clients, client families and fellow professionals.
Religious, moral, political and ideological beliefs are the foundations
of values, both personal and professional. British social workers
adhere to the British Association of Social Workers (BASW) Code of
Ethics for Social Work, which details core social work values and the
principles that flow from them. The Code of Ethics acts as a reference
tool when a worker is asked to make an ethical judgment, and is deemed
as a model of good practice.
The five core social work values as defined by the BASW
Code of Ethics are human dignity and worth; social justice; service to
humanity; integrity; and competence. . “Human dignity and worth”
refers to the social work belief in the inherent dignity and
self-determination of all individuals, mindful also of the worker’s
responsibility to society and the need to promote socially responsible
actions from their client. “Social justice” describes the worker’s
primary goal to support oppressed, vulnerable or poverty-stricken
persons and to promote social change in the interests of equality and
empowerment. In valuing their “service to humanity”, workers should
provide a service to people in need and work towards solutions for
social problems. There is an element of the work that will always be
pro bono. “Integrity” describes how workers should be trustworthy and
conscious of their responsibility to act in accordance with the
profession’s overarching values, while in the practice of the value of
“competence” promotes the continual building of expertise and
knowledge, and the strive to contribute to the knowledge of other
professionals. Workers should not practice outside their area of
expertise unless properly supervised. These values inform the ethics
code, and act as the moral framework for all social work decisions.
The General Social Care Council have used these values to form the
“Code of Practice for Social Care Workers and Code of Practice for
Employers of Social Care Workers” (2002). The code has statutory force
and applies to all social care workers across the Nation. The Code of
Practice allows proper enforcement of social work values and provides a
framework for ethical decision-making.
Personal values are formed by a complex interaction of diverse factors;
modelling, rules, social upbringing, religion and influence of
significant others. Personal values are not static and will evolve and
change through experience. Modelling refers to a value or thought
process, learnt through observation of others who demonstrate a
particular ideology. We often find we model our parents, or another
significant, influential person whom we respect. This may even be a
film star or song artist! It is the responsibility of all social
workers to be aware of the influence of their personal values upon
their responses to clients and decision-making processes, and to
compromise them with the values of the profession and their clients
through constant evaluation and perspective both of client progress and
satisfaction.
(2) Examine your own value base, biases and prejudices. (Describe
your initial reaction to the scenario. Demonstrate your understanding
of what constitutes a personal value and how these are formed and
influenced. Your reaction to the scenario may invoke negative feelings-
it is acceptable to discuss this.)
Ethical thinking involves critically reflective practice whereby one is
continually analysing personal and professional responses to clients
and situations. In order to do this effectively, workers must be aware
of their own values, biases and prejudices. Equally, awareness of
values pertaining to the client and their significant others, as well
as the values of other professionals will guide all ethical decision
making. In order to assess ones own values, biases and prejudices in
relation to the case study, one must consider how Danny’s “debilitating
illness” makes one feel. Does it induce feelings of sympathy? Perhaps
that he is abnormal? Some workers may feel uncomfortable in the
presence of a “once active young man with a promising football career”,
who now requires Personal Assistants to have all his needs met. My
personal response could be one of sympathy. This response is not
helpful for the client and is potentially disempowering for Danny. The
professional values of social work suggest that Danny should be viewed
as a competent young man with decision-making capacity; it is the role
of the social worker to support this, and not focus on his disability
as the primary feature.
Similarly, workers may feel prejudiced against Danny’s “accessing (of)
gay sites”. 64% of English citizens claim to have less positive
feelings towards at least one minority group; 17% of those have less
positive feelings to gay or lesbian people. It is also important for
the worker not to assume that Danny is homosexual at this point; the
situation should be taken at face value until Danny wishes to discuss
the issue further with someone he trusts. From a personal perspective,
I welcome the fact that Danny has found a way to explore his sexuality
and believe this should be encouraged. Research from the “Profiles of
Prejudice” (2003) showed that knowing someone who is gay, lesbian or
bisexual (LGB) decreases the likelihood of prejudice against this group
by half. As I, as well as my parents, have many LGB friends, I value
equality and freedom of expression for LGB persons. However, it
appears that Danny’s brother has concerns relating to Danny accessing
homosexual websites, which has led to him removing the computer from
Danny’s possession. This indicates a different and conflicting value
base relation to homosexuality than my own.
(3)Explain potential conflict between your personal and professional
values.(You need to think about the potential conflict between your
personal values and the professional values. You should discuss how
these could influence you in relation to the scenario. For example,
what you want to do on an individual level may not be the same as what
you should do as a professional.)
Our personal values are the “foundation upon which ethical principles
and standards are built” (Bond 1993). It is our ethical principles
that decide the actions we take in response to a particular situation.
The personal/professional value base only determines how a worker
believes he/she should respond; this can be contradictory to the actual
response - what he/she would like to do - or indeed what is in his/her
best interest. Hence values provide a benchmark for overall standards
of conduct, which we use to appraise the behaviours of others and
ourselves.
The paternal model of ethical thinking describes decision making based
on the furthering of a person’s wellbeing at the potential loss of
their freedoms, or their right to self-determination. Paternalists
will presume they are able to make a wiser decision than the individual
to whom the decision relates and this can result in a loss of esteem
and possible feelings of resentment. However, for other individuals,
the feeling of “being taken looked after” can be comforting,
particularly in times of distress. Nevertheless the paternalistic
approach is ultimately disempowering for the client; it results in an
imbalance between the client and the carer. Further, failure to curb
paternalistic action can erect a significant barrier to equality,
leading to oppression and disadvantage.
An alternative model of ethical decision-making is the utilitarian
approach. The basic premise of this model is “the greatest good for
the most people”. As social workers strive to promote social justice,
the utilitarian approach is a relevant and well-used ethical model in
the social care field. This model not only encompasses the welfare of
the individual, but also recognises that the promotion of public good
is equally important. Within this model, the worker encourages their
client to take socially responsible actions in order to create
beneficial outcomes for all.
Difficulties arise in social work when values conflict. For example, in
this case study there are potentially conflicting values between the
warden, Danny, his brother and the social worker. In social work,
confidentiality is a core value. However, the warden appears to have
taken a paternalist stance when deciding to inform Danny’s brother of
his use of homosexual websites. This goes against the core social work
value of client confidentiality and instead reflects the view that
“others know best”, indicative of the paternal model.
Within this case study, there is conflict between my
personal/professional values and those of Danny’s brother, which will
impact on the response I would decide to take in relation to the
removal of the PC. My personal values lead me to believe that Danny
should have his computer returned to him immediately in order to allow
him to cultivate his social networks, explore his sexuality and to
allow his independence to grow. However, as it is clear that my values
conflict with those of Danny’s brother, I would need to consider which
decision will produce the greater good. The value of human
relationships is well-recognised in social care values; hence it is
important to find a way to manage any potential breakdown in the
relationship between Danny, his brother and myself by the reinstatement
of the PC. Following the utilitarian model, careful consideration is
needed to establish which course of action will produce the greatest
benefit to all.
If the worker has particularly strong values that are contrary to the
professional values of social work, it may be necessary for the team
manager to consider a different worker to manage the case. In all
initial assessments, the allocation of the most appropriate worker is
crucial, and so the team manager should consider the workers knowledge
and understanding of the issues relevant for the client and his/her
family, whilst also ensuring the worker is an appropriate match in
terms of race and gender, where possible.
(4) Describe oppressive and anti-oppressive practice in relation to
the scenario. (You should discuss this in the context of the issues
presented within the scenario.)
To effectively consider the issues of oppression (which is a risk
factor in this study) and anti-oppressive practice, we should first
analyse the underlying issue that feeds oppression - negative
discrimination. Negative discrimination is defined by the attribution
of negative features with regard to an individual or social group
(Thompson 2003). Often negative discrimination relates to social and
biological constructs; it can be based upon gender, sexual orientation,
race, class, disability, religion, age and so on. It must be
acknowledged that social workers need to consider their personal values
when working with individuals or groups of a minority background.
Negative discrimination creates the conditions that nurture
oppression. Thompson (2001) defines oppression as:
“inhumane or degrading treatment of individuals or groups; hardship
and injustice brought about by one group or another; the negative and demeaning exercise of power” (pg 34)
Anti-oppressive practice is crucial in supporting social workers to
work in a non-discriminatory fashion, which upholds the ethics and
values of the profession. Anti-oppressive practice is hallmarked by
continuous critical reflection, this promoting empowerment and equality.
In relation to Danny, we should consider the power that is implied
through medical staff having superior medical knowledge, skills and
expertise in relation to Danny. There is not enough information from
the case notes provided to determine Danny’s long-term care plan, but
the review should consider whether his long-term care is based upon the
medical model, whereby the impairment is seen as the problem and his
dependence is emphasized (Davies, 2002). Thompson (2001) argues social
work should take a “demedicalised” view and look away from the
physiology, instead applying the social model of disability, described
by Davies (2002). The social model would argue that Danny’s needs must
be considered from a wider perspective, ensuring his social and mental
health needs are given equal consideration to his physiological needs.
Regarding societal constraints as the obstacle, and not the individual,
creates the mindset to consider how best to remove barriers to
mainstream social, political and economic life. The social worker
should liase with Danny and aim to build a solution-focused (not
impairment-focused) care plan; within the review, barriers should be
considered and solutions sought together, utilizing Danny’s strengths.
Danny has a debilitating illness. It is well documented that persons
with physical impairments have an increased likelihood of being
subjected to oppressive practices (Dominelli, 2002). Dehumanising and
medicalised language often leads to a loss of esteem and a feeling of
disempowerment for the physically impaired service user. Abstaining
from the use of medical or social work jargon, and providing lots of
opportunities, open discussion and questioning can help avoid such
condescension (Dominelli, 2002). Professionals should continually
check themselves for use of infantilising language and ensure they
engage in mature, adult discourse with Danny, thus ensuring they are
working in a way which promotes the dignity and worth of the client and
allows for self-determination, thus fostering the professional values of social work.
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