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Please take some time to read the following ethical scenarios. At the end of each scenario, there will be a couple of questions related to ethical decision making. Based upon your own knowledge of ethical decision making, write down your analysis of each scenario.

Each scenario should take you about 5 -10 minutes to read and analyze. When the analysis from our panel of experts is presented later in the training, you can see if you came to the same conclusions for the same reasons.

While some of the scenarios used in our training have been drawn from actual clinical practice, they are not able to fully approximate real life. In the ethical situations faced by each clinician in his or her practice, there will be opportunities to solicit more information from clients, opportunities to try things out to see what works, as part of an organic, changing process.

That fact that the trainee cannot engage in this living process means that the choices of how to proceed will be more limited, and that there may be no clear and certain answers to the scenarios. The importance of examining these scenarios, however, lies in deepening your understanding of how to engage in this complex, organic process. Towards that end, let us proceed.

Scenario Two

Marcy P. is a mental health clinician specializing in geriatric work. She has been working for several years with Irma S., a ninety-three year old female who has just been diagnosed with a terminal form of bone cancer, which has disabled her to the point where she requires a considerable amount of assistance in the tasks of daily living. In visits to Irma’s house, Marcy has been preparing Irma for the difficult road that lies ahead, with the prospect of a considerable amount of medical intervention and pain medication. One day in their session, Irma stops Marcy’s supportive interventions to ask for a simple favor: she wants Marcy to help her purchase an airline ticket to Oregon. When Marcy asks why, Irma smiles and reports that Oregon has the most liberal laws in the country concerning doctor assisted suicide. Irma goes on to say that she has led a full and rich life, and wants to depart her life with dignity, and without the need for all the attendant medical care that she is going to have to go through with her cancer. She says in the country and culture where she was raised, people who were ready to die would be allowed to do so, and she thinks this is a good thing. She says she would like for Marcy to help her make arrangements to find a temporary residence in Oregon, and travel arrangements. She reports that she has contacted the office of a doctor in Oregon whom she saw on television, and has made an appointment with him. She thinks this doctor would be willing to help with an assisted suicide. What are the legal and ethical principles at stake here, and how would you recommend that Marcy should proceed?

Write your answers, then continue

Scenario Three

Alan C. is a social worker who specializes in issues related to sex and sexuality. He has just agreed to meet with a new client, Ali M., who provided only sketchy information on the phone, saying the nature of the sexual concern was so personal he needed to discuss it in person. In the first meeting, Ali reports that his sexual concern is this: he is a devoutly religious person, and he has been fighting his impulses to engage in a ‘homosexual lifestyle’. His impulses run deeply contrary to his strongly felt religious beliefs, and to the beliefs of his culture. He is going to be returning to his home country in a few months, and he is worried about his safety and well-being if he cannot control his homosexual urges. He wants Alan to help him become straight. Alan’s very thorough study and research in this area has led him to a belief that efforts to “convert” homosexuals away from their sexual orientation are largely unsuccessful and can lead to additional emotional damage and disappointment, and such attempts are therefore inimical to Alan’s ethical obligations to promote more healthy approaches to sexuality and self-acceptance. What are the ethical considerations here? What issues related to values and diversity are at stake? What recommendations might you make to Alan regarding his handling of this situation?

Write your answers, then continue

This completes our presentation of scenarios. For now, please put your answers aside. Before we discuss the scenarios in detail, we will take some time to look at our principles related to leadership and authority, and the relationship between these two arenas and the ethical decision making process. This will help to explain the reasons why our panel of experts made the ethical decisions that they made.