Paternalism and Dual Relationships in Social Work

Paternalism and Dual Relationships Overview

• Paternalism: Ethical principle where professionals restrict a client's freedom for perceived best interests.
• Dual Relationships: Occur when professionals have additional roles with a client beyond the primary relationship.

Key Concepts

• Paternalism Defined:

  • Reamer (1999) defines it as restricting a subordinate's freedom in the "best interest" of that individual.
  • Sacrifices client autonomy for their own good.

• Types of Dual Relationships:

  • Roles: Different capacities in which professionals interact (e.g., neighbor, colleague).
  • Timing:
  • Prior to professional relationship.
  • During professional relationship.
  • After the professional relationship ends.
  • Behaviors: May include personal interactions like hugs, handshakes, or gift exchanges.

Ethical Considerations

• Dual Relationships:
  • Not all dual relationships are unethical but must be evaluated carefully by professionals.
  • Responsibility to assess risks of exploitation or harm.
  • Code of Ethics Highlights:
  • Maintain professional boundaries.
  • Acknowledge and mitigate conflicts of interest.
  • Avoid exploitation of clients.

Moral Hazards in Paternalism

• Risks:

  • Paternalistic actions, even with good intentions, can lead to significant moral dilemmas.
  • Examples include deciding what information to disclose based on perceived harm.

• Common Morality Framework:

  • Gert et al. (1997) suggest paternalistic actions require justification when ethical boundaries are crossed, necessitating violation of at least one moral rule.
  • Must occur without client consent.

Application of Concepts in Practice

• Identifying Ethical Dilemmas:

  • Social workers must recognize moral questions and conflicts from dual roles.
  • Client empowerment is essential, navigating the power imbalance.

• Case Application:

  • Use the common morality framework to assess justifiability of paternalism in individual situations.

• Guiding Principle:

  • Aim to do least harm while considering clients' expressed autonomy.

Learning Outcomes

• Define types of dual relationships and their implications.
• Discuss ethical frameworks relevant to dual relationships.
• Apply ethical principles to scenarios involving paternalism and dual roles.

Conclusion

• Understanding paternalism and dual relationships is crucial for ethical social work practice.

Informed Decision Making

• Informed Consent: Fundamental ethical obligation requiring clients to be fully informed before consent.
• Shared Decision Making: Collaborative approach between professionals and clients.

Learning Outcomes

• Recognize moral implications of informed consent in practice.
• Differentiate between processes and products of informed consent with moral ramifications.
• Analyze scenarios requiring court-mandated consent through a moral framework.

Informed Consent – Process & Product

• Process encompasses:
  • Signed Consent Form: Written permission from clients.
  • Verbal Consent: Spoken approval from clients.
  • Key Elements:
  • Disclosure: Clear treatment information and risks.
  • Understanding: Ensure clients comprehend the information.
  • Voluntariness: Consent must be voluntary, without coercion.
  • Standards: Compliance with laws and policies.

Elements of Obtaining Informed Consent

• Disclosure: Clients must understand what they are consenting to (Bryan et al., 2022).

Professional Guidelines for Social Workers

• Confidentiality: Protecting client information and managing breaches.
• Self-Determination: Respect autonomy, encouraging informed decision-making.
• Professional Disclosure: Informing clients about services, costs, and rights.
• Requirement of Valid Consent: Provide services with valid consent per legal requirements.

Moral Rules Related to Informed Consent

• Do Not Do Harm:
  • Prohibitions against killing, causing pain, or depriving freedom.
• Do Not Deceive: Maintain truth and duty, adhere to the law.

Moral Reasons for Informed Consent

• Compliance with moral rules: Avoid deception, ensure informed decisions to prevent harm.

Competence, Rationality, and Informed Consent

• Determining Competence: Assessing a client's ability to make rational choices regarding consent.
  • Four Factors Impeding Decision-Making:
  • Understanding, appreciation of information, coordination with values, presence of disabilities.

Coercive Environments and Informed Consent

• Recognizing Coercion: Identify if clients are in coercive situations to ensure informed consent.
• Vulnerable Populations: Address power imbalances in professional-client interactions.

Paternalism in Professional Practice

• Acting for clients' good while violating moral rules necessitates justification.
• Elements of Proper Consent:
  • Clear information disclosure, voluntariness, and competency in decision-making.
• Avoid paternalistic interventions as a management safety net.

Ideal Consent vs Valid Consent

• Valid consent respects moral rules with adequate client information.
• Ideal consent focuses on preventing irrational choices and protecting clients’ interests.

Challenging Client Choices

• Professionals may intervene if clients make contradictory or irrational choices.

Concluding Thoughts on Informed Consent and Morality

• Ethical consent reduces suffering beyond compliance—reflecting context enhances integrity.

Self-Determination and Confidentiality Key Concepts

• Self-Determination:
  • Definition: Autonomy in personal decisions, foundational for individual governance.
  • Importance of assisting clients towards goals and informed decisions, intervening only in exceptional circumstances.

Limits of Self-Determination

• Influencing factors include societal laws and individual desires, which create practice tension.

Self-Determination Theory (SDT)

• Core Needs for Positive Change:
  • Autonomy: Freedom in choices without coercion.
  • Competence: Feeling effective and capable.
  • Relatedness: Importance of supportive relationships.

Ethical Decision-Making Model 6Q Model

• Questions include:
  • Who is helpful? What are the choices? When faced similar dilemmas? Where do guidelines lead? Why this action? How to enact the decision?

Decision-Making Tests

• Publicity Test: Is it justifiable publicly?
• Reversibility Test: Would I want this for myself?
• Smell Test: Does it feel right?
• Mom or Mentor Test: How would a respected individual view the decision?

Additional Readings

• SDT in Social Work: Kirzner & Miserandino (2023) on fulfilling basic needs for well-being.

Competence and Non-discrimination Overview

• Focus on competence and non-discrimination in ethical practice and professional growth.

Competence in Professional Practice

• Definition: The trust clients place in professionals' ability to provide effective care.
• Elements: Knowledge, experience, self-care, ongoing education, and consultation.

Moral Values Related to Competence

• Beneficence: Act in clients' best interests.
• Non-maleficence: Avoid client harm.

Challenges for Newly Employed Social Workers

• Cultural competence challenges impacting client rapport and understanding.
• Peer support is vital for professional growth and cultural awareness.

Non-discrimination in Professional Practice

• Definition: Ensuring equitable treatment regardless of identity factors.
• Cultural Competence Elements: Awareness of biases, intersectionality understanding, commitment to inclusion.

Moral Values Related to Non-discrimination

• Dignity and worth of all, equity, social justice, and relationship dynamics.

Learning Outcomes Summary

• Define concepts of competence and non-discrimination, identify moral values, and resolve dilemmas theoretically.

Moral Disagreements Class Overview

• Discuss sources of moral disagreement and analysis of moral decision-making cases.

Sources of Moral Disagreement

• Includes differing prioritizations and interpretations of ethical guidelines.

Examples of Moral Disagreement

• Discusses euthanasia, rule interpretation, and animal rights.

Competency Determination Framework

• Cognitive understanding and rational decision-making assessments.

Important Moral Features

• Importance of confidentiality and informed consent alongside dual relationships.

Ethical Decision-Making Process

• Blockages can include biases and self-interest, but empathy can support ethical clarity.

Ethical Maturity

• Reflects the ability to discern right and wrong, implementing decisions through learning.

Real-World Application: Case Study of Bob

• Evaluating client competence in decision-making while balancing medical perspectives with ethical autonomy.