Ethical Dillemmas and Decision Making Processes - Coursework Example

In this paper I will attempt to briefly describe various ethical frame-works that are currently used to evaluate and critically engage with the relevance and urgency of values in social work. I believe it is important to do so because it helps us understand, grapple with and clearly articulate the complexities and contestations involved in values in social work thus helping to build shared meaning and provide alternate explanatory frameworks to aid analysis of ethical dilemmas. This in turn better equips us to resolve ethical dilemmas occurring during practise of social work in real-life situations. The process of reflection on ethical issues is a level deeper than a concrete problem-solving exercise that may not require an in-depth exploration of personal values. A combination of these two can not only decrease the ease with which social workers may come to a decision in crisis situations that require delicate handling but also provide us with a richer understanding of the stakes involved in this profession and encourage us to constantly reflect upon our own dispositions and actions, thus ensuring greater ethicality in our practise and leaving open the possibility of constant dialogue and support. In this light, I will move on to examine the vignette provided and attempt to analyse it in relation to the various ethical frame-works and directives for social values that are available in the field of social service. I will also try to point out, staying within the scope of this essay, the critiques of the various theories that I elaborate on as well as my own take on some of the issues discussed. Ethics is the branch of philosophy that inquires into the normative and moral evaluation of human actions. Normative ethical systems have been classified into three categories: deontological, teleological and virtue ethics. Let us look at these three systems of ethics in some detail. Immanuel Kant put forth the rational principle of ‘categorical imperative’ of which the following two formulations are extremely well-known and captures his idea brilliantly: “Always act in such a way that you can also will that the maxim of your action should become a universal law”, “Act so that you treat humanity, both in your own person and in that of another, always as an end and never merely as a means”. Kant’s ideology follows a model of deontological or duty-based ethics. Deontological systems focus upon adhering to independent morals or values in our actions to enable us to do our duties correctly and asserts that the ability to follow one’s duty is the right way to conduct ourselves and that these moral rights are to be determined objectively and absolutely, not subjectively. While there is an emphasis on ‘correct motivations’, they alone form no substantive basis on which actions can be legitimized. Instead, an adherence to the correct moral duties is what stands prioritized. Such a model is problematic in two fundamental ways. One, by insisting that following one’s moral duty can ensure adherence to correct moral choices is problematic in that it is a top-to-down model. Here the focus is not on the ability of a person to critically reflect on the particularity of a situation and choices at hand and determine a response with regard to teleology, but to say that a general adherence to one’s duties will take care of the moral correctness of the choice made. One may even say that in such a case, there is no question of making a choice since there is no room for dilemma in the first place. Such a position is fatal to the essential use of criticality to determine what should be the response to a particular difficulty at hand. Second, when it is ascertained that the correct moral value has been adopted and the correct moral duty followed, the consequence, however unpleasant, is not deemed wrong; moral principles and the consequences they engender stand in an irresolvable divorce. Further, a deontological viewpoint does not validate actions that are can be regarded as immoral when they are solely based on a subjective perception. While deontological ethical theories such as divine command, duties theories and monistic deontology may be readily read as problematic given the fact that civil society life and practice of religion exist in a sharp public-private theoretical divide in Western societies, others such as Libertarianism (Rights theories) and Contractarianism are capable of obscuring the injustice or normativity that they carry in that they derive their legitimacy from what may be broadly called the social-contract theory. Thus the justification for these deontological theories does not derive from religion but from a ‘secular’ imagination. This secularism by assuming universal consensus on an ideology that has an ontological-historical specificity imposes violence on its dissenters. An insistence on objectivity fails to take into account demands for ‘justice’ that isn’t merely normative, but substantive. Universalist, normative values are derived from specific moral universes that have a historical particularity to their origin. It is such an origin that is erased by the insistence on objectivity. Social values must, as Derrida puts it, ‘always concern ‘individuals’, irreplaceable groups and lives, the other or myself as the other in a unique situation’ (Derrida, Jacques, 1990). It might now seem that I am arguing for a consequentialist moral system, one that derives its justification from teleology, the consequences of an action. Utilitarianism is one example of consequentialism where the emphasis is on quantitive maximisation of the resultant good that can arise from a particular action. Thus, an action that results in ‘good’ and happiness is deemed correct. There is a further distinction within consequentialism, between act-consequentialism where the emphasis is on the specific outcome of an act and rule-consequentialism that has much resemblance to Kant’s categorical imperative. Having rejected the possibility of general rules being able to deliver justice in what are specific circumstances, we find rule-consequentialism guilty of criticism similar to deontological moral systems. Critics of act-consequentialism have pointed at “the impossibility of actually determining the full range of consequences any action will have”, that “there is much disagreement over how or even if different consequences can really be quantified…, if it is possible to argue that enough good will result”, because then “any outrageous and horrible actions would be justified” and also that if the morality of an action is dependent upon all of its consequences, then “consequences will reach far and wide” in ways that may not be possible to anticipate or comprehend (Cline, Austin. Teleology and Ethics). The problem I find with the desire evident here to declare a particular moral approach as good or valid and subsequently also with its criticisms is that they exhibit a tendency towards generalisation. Thus, though the topic under scrutiny is the consequences of specific actions taken in response to unique situations, couched in a language that is general and trying to arrive at the moral validity of such an approach in all situations, the tendency is to arrive at a norm. It is precisely this tendency that I would like to hold at bay. The third model, virtue-based ethical theories, places much less emphasis on which rules people should follow and instead focus on helping people develop good character traits, such as kindness and generosity. These character traits will, in turn, allow a person to make the correct decisions later on in life. Virtue theorists also emphasize the need for people to learn how to break bad habits of character, like greed or anger. These are called vices and stand in the way of becoming a good person. We immediately notice that this theory sounds similar to indirect and restrictive utilitarianism where the emphasis is on development of the right attitudes and principles in a person so as to lead to actions that will bring maximum pleasure to people. There are several documents released by recognised social service agencies that seek to codify and enumerate the responsibilities and values expected of a social worker. The intention is to achieve a common standard of work ethic for social work practitioners, enabling a consensus regarding what should constitute their ethical inclinations, in turn helping to co-ordinate and make viable social service as an institutionally structured business. It seeks to help social workers play a part in the regulation of the workforce and the support of ‘high quality’ social care, effectively compelling them to adhere to the standards set with regard to behaviour and professionalism. Thus the first document released in an international capacity by the General Social Care Council in September 2002, Code of Practice for Social Care Workers and Code of Practice for employers of Social Care, describes itself as “a key step in the introduction of a system of regulation for social care in the four countries of the UK” (General Social Care Council, 2002, pp. 3). Further, “the Code of Practice for Employers of Social Care Workers sets down the responsibilities of employers in the regulation of social care workers” (General Social Care Council, 2002, pp. 4). It is normative and institutionally sustained in so far as it demands that “the code requires that employers adhere to the standards set out in their code, support social care workers in meeting their code and take appropriate action when workers do not meet expected standards of conduct” (General Social Care Council, 2002, pp.11). The general directives that this code puts forward for a social worker as mentioned below. • “Protect the rights and promote the interests of service users and carers; • Strive to establish and maintain the trust and confidence of service users and carers; • Promote the independence of service users while protecting them as far as possible from danger or harm; • Respect the rights of service users whilst seeking to ensure that their behaviour does not harm themselves or other people; • Uphold public trust and confidence in social care services; and • Be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills”. (General Social Care Council, 2002, pp. 13) In the example above, we find that notions of moral-ethicality in social work practice are represented in the form of codified ethics together with representations about how ethical practice might be achieved. I wish to argue that such a code is a mode of cultural pedagogy, one that seeks to establish modes of learning and belief systems. Systems of power relations frame social work practice through the economic imperatives governing its institutionalisation as well as the manner in which it constrains the ability of a social care worker to arrive at justice goals. Not only so, but also that the pervasive pressure of hegemonic ideologies in constituting such codified spaces of expression for a social worker also renders invisible alternate discursive practises that aim towards the ideal of ‘justice’ as well. Let us now move on to the vignette provided for a qualitative analysis. Vignettes are a device used to aid research about questions regarding the nature of the relationship between values and action which are central to the study of social work ethics. By analysing the vignette given, we can appreciate the complexities that often accompany social work situations and the ethical dilemmas that ensuing decision making processes engender. By locating the conflicts arising in such a hypothetical situation made to simulate real-life scenarios and understanding them through various ethical frame-works, we appreciate the critical engagement that such situations demand and learn to hone our analytical skills to deal with crisis situations. Mrs Angela Smith is a 34 year old woman who has a daughter called Jane. Jane is 15. Jane has a learning disability. Angela has bi-polar disorder. Angela is currently unwell and is being supported by the local community mental health team. Jane has a partner called Adam. Adam is 19. They met at a local disco. A friend of Angela’s told Angela that Jane and Adam are having a sexual relationship and that she had seen Jane and Adam looking around Mothercare. At the weekend Angela’s condition deteriorated and she was admitted to hospital. Jane went to stay with her despite carers Mr and Mrs Howells. Yesterday the social worker received a telephone call from Mr Grey – a teacher at Jane’s School. Mr Grey did not know what to do as Jane was distraught and refusing to return to Mr and Mrs Howells, as she said they were not allowing her to see Adam. The question that needs to be answered is, what should the social workers, Mrs and Mr Howells do, given the circumstances? Jane is in teen-age, a period in our life-span which is considered to be extremely unsettled, confusing and as well as one that marks the beginning of awareness of one’s own sexuality. Can we put aside contentions that these are generalised and normative judgements of psychology and assume that Jane is indeed a ‘typical’ teenager? Further, should we be sympathetic to her because she has a learning disability? Jane’s mother, Mrs. Angela Smith, has bi-polar disorder. Thus both Jane and her mother come under a medical care requirement. We already have the first ingredient for our recipe for complexity. What if the social worker makes a decision assuming that Jane is just a confused teenager, who cannot appreciate the delicacy of the situation at hand? Would it be justified? Should Mrs and Mr Howells take into consideration the fact that she has a learning disability? How far should this knowledge influence their decision? The social workers’ primary responsibility is to take care of Mrs. Smith and restore her to normalcy as soon as possible. Jane’s absence could worsen her mother’s condition. Is the worsening of her condition due to the knowledge that her daughter is having a sexual relationship with Adam? Given the fact that we are told that Jane and Adam were looking around ‘Mothercare’, we can assume that they don’t want to take care of Mrs Smith personally in the future and this information should also have affected Mrs Smith’s health. On the other hand, what legitimacy should the social worker give to Mrs Angela Smith’s opinions about her own health, mental condition and responses to the news that her daughter has a boyfriend, given the fact that she has bi-polar disorder1? In such a situation where opinions and perceptions are subjective, there cannot be one objective rule that may be applied to resolve the crisis as a deontological model might suggest. A person’s opinion on a matter may be understood as by himself as ‘autonomous’. But post-modern critiques have pointed out the ideological nature of such a perception itself. Thus, a virtue-based model insisting that social workers’ have the necessary goodness and sensitivity that may predispose them to fairer judgements is good if social workers existed outside social discourses that constitute subjectivity and perception. Thus, in this particular situation, I would choose an act-consequentialist ethical model for the decisions to be based upon, since the delicacy of the situation is dependent on being able to keep Mrs Smith as well as Jane happy. A failure to do so at this particular moment might lead to Jane’s insistence that she will not return to Mrs Smith, which will affect her mother’s health adversely. Also, a regulation by the social workers’ that Jane does not see Adam can only make her more stubborn at this point. If Mrs and Mr Howell have a convincing reason for Jane as to why she shouldn’t see Adam, this is not the moment to push it. Hence I would advice Mrs and Mr Howell to say nothing about the matter to Mrs Smith but go to the school and speak to Jane in person. They should tell Jane that Mrs. Smith is not taking the information that her daughter has a relationship with Adam particularly well and this is what has made her more ill. Spoken to with affection, there is a great likelihood that Jane will understand this situation. Jane should be apologised to, by the social workers’ for not having allowed her to see Adams and arrangements should be made so that Jane meet Adams provided it does not happen in her mother’s presence. This decision is contingent on the fact that this moment, now, requires a particular resolution. Once the immediate crisis has been resolved, strategies have to be reformulated and decisions made accordingly. As I have demonstrated, it is a constant flux, an unceasing fluidity that is required of decisions made during similar moments of crisis that holds my attraction towards post-modern critiques of social care. It is impossible to hold generalised values that can simply change contexts and be effective in delivering justice. The particularity of the moment and an ethical investment in it is the need of the hour. Which particular frame-work of ethical approach may make possible such justice at a specific moment is what lends it validity, a validity that lasts no longer than the moment itself. Bibliography Adams J ,1995, Risk, UCL Press, London. Asquith, Merrylyn, 2002, Ideals, Myths and Realities: A Post-modern Analysis of Moral-Ethical decision-making and Professional Ethics in Social Work Practice. (PhD dissertation) University of South Australia, Available at http://www.library.unisa.edu.au/adt-root/uploads/approved/adt-SUSA-20030418-110714/public/01front.pdf Assuring Quality for Mental Health Social Work: Requirements for the Training of Approved Social Workers in England, Wales and Northern Ireland and of Mental Health Officers in Scotland. March 2002.Central Council for Education and Training in Social Work, London. Banks, S. ,1995, Ethics and Values in Social Work, Macmillan, Basingstoke. Beach L, R. ,1990, Image Theory: Decision -Making in Personal Organisational Contexts, John Wiley and Sons Chicester. BASW ,1998, Mental Incapacity and Decision Making Professional Implications for Social Workers, Birmingham, BASW. BASW ,2001, The Code of Ethic for Social Work, BASW, Birmingham. Bipolar Disorder. Department of Health and Human Services, National Institute of Mental Health. Available at http://www.nimh.nih.gov/publicat/NIMHbipolar.pdf Cline, Austin. Teleology and Ethics. Available at http://atheism.about.com/library/FAQs/phil/blfaq_phileth_teleo.htm Codes of Practice for Social Workers and Code of Practice for Employers of Social Care Workers. 2002 September. General Social Care Council. Derrida, Jacques, tr. Mary Quaintance, July-August 1990 ,‘Force of Law: The Mystical Foundation of Authority’, in Deconstruction and the Possibility of Justice, a special issue of Cardozo Law Review, vol. II, nos 5-6, p.949. GSCC .2002. Codes of Practice for Social Care Workers and Employers, GSCC, London. Hugman, R. and Smith, D. ,1995, Ethical Issues in Social Work, Routledge, London. Wilks, Tom, 2004, The Use of Vignettes in Qualitative Research into Social Work Values. Sage Publications, London. . . Codes of Practice for Social Workers and Code of Practice for Employers of Social Care Workers. 2002 September. General Social Care Council. Read More