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ETH8283 - SECTION 2: SCENARIOS

 

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, leadership, and the uses of authority. Based upon your own knowledge of these areas, write down your analysis of the principles involved in making good ethical decisions related to the scenario.

Each scenario should take you about 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 these scenarios have been drawn from actual clinical practice, they are not able to fully approximate real life. In the ethical situations faced by each clinician, 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 One

Ron B. is a clinical social worker who specializes in Attention Deficit Disorders. He has seen Arthur M., a 10 year old with ADD with hyperactivity, for two assessment sessions. At both sessions, Arthur’s mother and father have been present. During these assessment sessions, both parents have made it very clear to Ron that they expect that individual counseling for Arthur will be the approach taken. Ron has explained very gently and diplomatically that individual therapy is not usually recommended for children with ADD, as it has been shown to be significantly less successful than family therapy, support, and education. At the start of the third session, Arthur’s father shows up with Arthur and tells Ron to see Arthur individually, saying that the family would drop out of therapy if Ron “couldn’t do his job and fix Arthur’s problems”. What ethical and leadership principles are at stake in this scenario and how would you approach finding the most ethical course of action?

Write your answers, then continue

Scenario Two

Ellen P. is a social worker specializing in chronic medical problems. For several years she has been running a support/therapy group for people with chronic medical problems. The group often receives new members from people Ellen has seen first in individual counseling. Her group has instituted a rule that prohibits members from having romantic relationships with other people in the group, a rule that Ellen has championed for a number of important clinical and boundary reasons. Recently, a member of the group, Gary G., has stopped attending without providing the group or Ellen with any reason for his departure. Shortly after this, another member of the group, Jill C., also drops out of the group and asks to start seeing Ellen again in individual counseling for some “urgent things that have come up.” In the first individual session, Jill reports to Ellen that Gary had dropped out of the group because he wanted to begin a romantic relationship with Jill. Jill has since begun to date him, and they have gone out on a couple of occasions. Ellen is concerned, because, although Gary has acknowledged to the group that he has Hepatitis C, he did not disclose that he also has HIV. Ellen, however, is aware of his HIV status, since the information was disclosed in Gary’s individual sessions. Ellen is aware that, if the couple becomes sexually active, Gary’s HIV status holds serious risks for Jill. What are the leadership and ethical responsibilities here? What laws governing confidentiality might be involved in this scenario? How would you approach finding the most ethical course of action?

Write your answers, then continue

Scenario Three

John R. is a clinical social worker with an established relationship with a managed care panel. A new client, Pamela B., has just been referred to him and she calls him to set up an appointment. When John begins to talk to her, it becomes very clear that she is in crisis. She is extremely depressed and gives John information that lets him know that she is actively and presently suicidal, with clear indicators of imminent risk. Pamela tells John that the managed care panel knew about her suicidality, and told her to try to get in to see John as quickly as possible for an assessment. John tells Pamela that he is not the most appropriate party to provide the level of immediate care that she obviously needs. He tells her to hang up and call the emergency number on her insurance card and tell the care manager about her suicidal ideation and plan. Pamela agrees to do so, and terminates the call. What are the ethical and leadership issues at stake here, and what, if anything, would you have done differently?

Write your answers, then continue

Scenario Four

Sheldon J. is a social worker in a community mental health center, specializing in work with adolescents. He has begun to see Will A., who will be 17 in two months, and whose mother has brought him in for oppositional and defiant behaviors. Sheldon works very hard with Will for several weeks, establishing a good therapeutic relationship. Two weeks before his seventeenth birthday, Will confides to Sheldon about a “problem with drugs” that he has never brought up before. The reason he hasn’t brought it up is that his mother kicked Will’s older brother out of the house when she found out he was doing drugs, and he knows his mother will do the same with him if she finds out. In Sheldon’s assessment of Will’s mother, he concludes that Will is almost certainly right. Sheldon also concludes that Will needs Intensive Outpatient treatment for the drug problem, which would probably require payment by Will’s mother. What are the ethical and leadership principles at stake here and what course of action would you recommend?

Write your answers, then continue

Scenario Five

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, Jared 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, Jared 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 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 leadership and 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 first group 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.


 

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