SCWK 3720 - Chapter 4: Client Autonomy, Self-Determination, and Informed Consent

Autonomy

is the ethical principle of promoting liberty, choice, self determination, or independence; Uninhibited by restriction or control from the state of others"

- derived from greek, meaning "self-rule"

Autonomy - Context for Practice

- Respecting clients right to self determination and right to make decisions about matters affecting their lives

- Rejection or acceptance of services

- Empowerment - empowers clients to make their own decisions

- Ensuring client voices are heard in contexts outside of the

service user/ provider relationship

- Rejecting liberalism models of agency

Liberalist models of agency

value professional knowledge as the only knowledge, minimizing agentic capacity in service users

Self-Determination

is the right and ability of individuals to make their own decisions and determine their own lives. It refers to respecting a person's autonomy, and their right to make decisions regarding their personal goals, needs, and actions

Self-Determination - Context for Practice

As social workers, we should never reflect our personal values onto our clients. In order to allow them to practice their right of self determination ,it is crucial to collaboratively work with clients.

Limitations of Self Determination

1. When a client is at risk of harming themselves or others

2. When a client has limited mental capacity

3. When a client is a minor

4. When there are Legal or Ethical obligations

Informed Consent

involves providing clients with accurate information about interventions.

Ex: How do they work, and what are some potential risks and benefits?

The process may also include discussing the negative and positive repercussions of not engaging in any intervention

Violations of Informed Consent

•imposing decisions on clients through threats, coercion, dishonesty, or trickery;

•failing to provide clients with sufficient facts and knowledge to allow them to make informed decisions;

•explaining services or interventions using language that clients cannot understand;

•preventing clients from choosing to withdraw from services; or

•obtaining consent from clients who do not have the necessary mental capacity to provide consent

Mental capacity

The ability of a person to think, reason, and remember

Social workers trained in the four decision-making components can complete a formal assessment when there are concerns about an individual's ability to provide informed consent (e.g., lack of mental capacity)

Four Decision-Making Components

(a) "the ability to understand relevant considerations"

(b) "the ability to understand and appreciate the risks and benefits of various treatment choices"

(c) "the ability to compare decision choices and think rationally about them"

(d) "the ability to communicate a stable treatment choice"

Substitute decision-makers

have the authority to make decisions on behalf of aperson who lacks capacity

Considerations of SDMs

If an adult lacks capacity and does not have an SDM, consent is sought out from their next-of-kin (Barksy, 2022).

Consent for children who are too young or lack capacity is sought out from their parent(s) or guardian(s) (Barsky, 2022).

Consent in Organizations and Communities

● When working with clients who are organizations or communities, we need to seek consent from someone authorized to give consent on behalf of the organization or community (Barsky, 2022).

● We may check bylaws, policies, charters, or constitutions to determine authority (Barsky, 2022).

● Important to include the individual members of the organization or community in setting goals (Barsky, 2022).

Consent in Research

Informed consent allows individuals to decide whether to participate in research without pressure or coercion, with the information they need about the research provided in easily understood language

Fully Informed Consent

This means that participants "...have a right to full, accurate, and honest information about the nature of the research, the risks and benefits of the research, and what is expected of them"

Voluntary Consent

This means that potential participants should be able to choose whether or not to participate in research and withdraw from it

Written Consent

Written on paper. It is generally preferred to oral as it provides proof of consent

Consent in Families and Groups

● When we work with families, we strive to achieve a consensus among all family members on their goals and the services they will receive

● Family members who lack capacity should also be considered

● For consent in groups, we want to consider how to accommodate the perspectives of every member

.● Informed consent occurs when clients agree to participate in a group