InDepth Notes on Self-Determination and Confidentiality

Class Overview

• Instructor: Susan Stevens, BSW, MEd, RSW, CHE, EXTRA Fellow
• Course: MSVU FSGN 3401 - Contemporary and Professional Ethical Issues in Families and Aging

Key Concepts

Self-Determination

• Definition: Autonomy and control over personal decisions
• Importance: Fundamental right allowing individuals to govern their lives
• Respect for Autonomy:
  • Assisting clients in identifying their goals
  • Supporting informed decisions
  • Intervening only in exceptional circumstances (e.g., imminent risk to self or others)

Limits of Self-Determination

• Factors Influencing Limits:
  • Societal: Laws and cultural norms
  • Individual: Personal desires, values, beliefs, and capabilities
• Tension in Practice:
  • Helps professionals when clients appear to act against their best interests

Self-Determination Theory (SDT)

• Core Needs for Positive Behavioral Change:
  1. Autonomy:
  • Freedom to make choices without external coercion
  • Not constrained by others' expectations
  1. Competence:
  • Feeling effective in choices and actions
  • Opportunity to express and expand abilities
  1. Relatedness:
  • Importance of supportive relationships
  • Feeling respected and cared for

Ethical Decision-Making Model

6Q Model

• Key Questions to Guide Decisions:
  1. Who will be helpful?
  • Consult with supervisors, colleagues, specialists
  1. What are my choices?
  • Assess alternatives and consequences
  1. When have I faced a similar dilemma?
  • Reflect on past experiences for insights
  1. Where do ethical and professional guidelines lead me?
  • Consider rules, values, and standards
  1. Why am I selecting a particular course of action?
  • Examine motives and underlying rationale
  1. How should I enact my decision?
  • Develop a clear process for implementation

Decision-Making Tests

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

Case Study: Mrs. Olivia Carvery

Background

• Client Profile: 85-year-old African Nova Scotian woman living alone
• Situation: Hospitalized due to a hip fracture and facing discharge
• Conflict: Disagreement between client (Mrs. Carvery) and health professionals regarding discharge plan

Key Issues in the Case Study

• Client’s expressed desire to return home vs. medical concerns for her safety
• Importance of respecting Mrs. Carvery's autonomy despite health professionals' concerns
• Influence of family dynamics on decision-making (e.g., daughter's concerns)

Additional Readings

• Self-Determination and Social Work: Kirzner & Miserandino (2023) on values in social work
• Informed Consent: Thannhauser et al. (2022) on confidentiality and practitioner disclosures

Next Week's Focus

• Topics: Professional Boundaries and Confidentiality
• Readings: Related articles to understand complexity in boundaries and ethical dilemmas in social work.