2 Module 1: Ethical Dilemma Introduction In the case of Mr. Jenkins, an 81-year-old White male who was diagnosed seven years ago with Alzheimer's disease, his ethical dilemma is if the daycare staff will refrain from providing life-sustaining interventions in the case of a life-threatening medical situation (e.g., cardiopulmonary resuscitation). Encourage that his health and well-being are first and foremost as legal implications and professional ethics. Gathering information reveals that Mr. Jenkins has Alzheimer's disease, lives at home with his wife, attends a childcare center, and was recently diagnosed with cancer. He cannot articulate his requirements, execute everyday tasks, and make educated medical decisions. Mr. Jenkins lacks an advanced healthcare directive. Application of the Nine-Step Ethical Decision-Making Model Step 1: Identification of Ethical Dilemma An ethical dilemma in social work is when a social worker must know how to deal with two or more moral principles or values. For example, a social worker may have to decide whether to respect a client's confidentiality or to report a threat of harm to someone else. Therefore, there is no perfect solution, and social workers must use ethical decision-making models and frameworks to guide their practice. Step 2: Core Principles and Competing Issues Some competing values are: Ethical decision-making is a process that can be challenging for social workers with no solutions to solve ethical matters. Ethical judgment is necessary when social workers consider honest social work services' standards, principles, and values (Barsky, 2017). As social workers, they respect people's values and dignity. Social workers work with each person with compassion, respect, personal variations, and cultural and racial diversity. They encourage clients to make responsible decisions (Barsky, 2017). Social workers try to increase by improving their chances and taking responsibility for their well-being. Core principles must be considered in looking at Mr. Jenkins' case, personal dignity and worth as it is tied to self- determination and responsibility. The chance that social workers ask and use the principles to decide how the client's coherent decision is not to receive life-sustaining interventions or decisions influenced by family members who experience financial difficulties. For example, service vs. social justice, dignity and worth of the person vs. importance of human relationships, integrity vs. competence, and service vs. competence. Step 3: NASW Code of Ethics The NASW Code of Ethics stresses honoring clients' right to self-determination and fostering their well-being in Step 4: Choosing a plan of action. Mr. Jenkins' family is acting on his behalf since he needs more decision-making capacity. Their desire is in his best interests, implying that The course of Action 1, following the family's wishes, is the best option. Hebenstreit (2017) states that social workers' professional behavior is protected and guided by the NASW code of ethics. Although social workers have experience in the environment, they still must abide by the guidelines. Social workers must help anyone unable to speak for themselves, just like Mr. Jenkins, who does not have a medical directive. Even, NASW codes are used to make an ethical decision by giving the client social services to the expectations of social workers (Barsky, 2017). Our mission and goals are to care for anyone unable to speak for themselves. As social Workers, our values are what we use to embrace our ethical perspectives while striving to meet the unique purpose at hand. These are the values we must go by (Barsky, 2017) Social justice 3 Service Competence Integrity Importance of human relationships Dignity and worth of the person Dilemma or Problem Identification The NASW codes do not explain or give constant criteria under the standards, values, or principles that would rank us according to the hierarchy of usefulness during dilemmas or conflicts (Barsky, 2017). The standards and moral values are ranked as they contradict social workers and have reasonable disagreements. Mr. Jenkins is an 81-year-old man who has the disease of Alzheimer's for the past seven years, and he found out that he now has cancer. The daughter has asked the center staff not to give him life-sustaining interventions to Mr. Jenkins. Step 4: State and Federal Laws and Regulations The legalities for the case of Mr. Jenkins are from the state of Texas. According to the NASW Code of Ethics (1.07), social workers should respect and protect the confidentiality and privacy of their clients, and disclose or share their clients' information only with the client's consent or as required by law (Barsky, 2017). Social workers should inform clients of the limits of confidentiality and the circumstances under which disclosure may occur. According to the TSWPA ($781.404), social workers must report any information that indicates that a client is likely to harm themself or another person unless the information is privileged or confidential under other laws (Barsky, 2017). Social workers should report such data to the appropriate authorities, such as law enforcement or protective services, and take reasonable steps to prevent the harm from occurring. According to the TAC ($781.213), social workers should document and maintain accurate and complete records of the services and supports that they provide to their clients (Cornell Law, 2023). Social workers should also comply with the ethical and legal guidelines for documenting and reporting their actions and the outcomes of their interventions. Social workers should also seek consultation or supervision from their colleagues or supervisors and address any ethical issues or dilemmas that may arise (Cornell Law, 2023). These are the legal materials found on the Cornell Law School website for the state of Texas. The Texas State Board of Social Worker Examiners (TSBSWE) oversees the licenses and regulations for social workers (Barsky, 2017). The Texas Social Work Practice (TSWPA) has definitions in place for social workers (Cornell Law, 2023). The Texas Administrative Code (TAC) is a compilation of state agency rules in Texas. ("Welcome to the Texas Administrative Code") ("Welcome to the Texas Administrative Code") The National Association of Social Workers (NASW) Code of Ethics is the national code of ethics that guides the social work profession in the United States (Barsky, 2017, pp. 44-46). The NASW Code of Ethics sets forth the values, principles, and standards social workers should adhere to in their practice (Barsky, 2017). The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects the privacy and security of health information (Barsky, 2017). Step 5: Consultation with Colleagues, Supervisors, and Legal Experts The importance of involving colleagues, supervisors, or legal professionals in an increase of conflicting situations where final and viable decisions take time to determine. The determination is closely connected with the integrity value, which mandates social workers to behave in a manner that reinforces trust (Reamer, 2019). This is an excellent opportunity for Mr. Jenkins to get an advanced health care directive that can educate him about the importance of life-sustaining interventions for social care clients with terminal illnesses like cancer. His senior family members should also be invited to voice their concerns. To ensure that Tarrant County, Texas laws of social work are fully adhered to; legal experts can also be invited with informed. consent from the client. 5 Step 6: Actions 6 Inform Mr. Jenkins of my duty to report and explore his reasons and alternatives for harming his partner: This course of action would respect Mr. Jenkins' right to self- determination and informed consent, and to express how he feels and thinks. How to be able to resolve his conflict with his spouse. However, this action may also trigger Mr. Jenkins' anger or defensiveness, making him less cooperative or more determined to carry out his plan. It may also put his spouse at risk of harm if he decides to act before I can report or intervene. Contact Mr. Jenkins' spouse or the police without his consent: This course of action would protect Mr. Jenkins' partner's safety and prevent Mr. Jenkins from committing a crime or harming himself or others. However, this course of action would also violate Mr. Jenkins' confidentiality, privacy, trust, and relationship with me. It may cause him to feel as if there was no one to protect or defend him in his most time of need. Step 7: Course of Action When working with clients who are mentally unstable or very old, it is essential for social workers to engage the clients or their representations in records closely. It concerns the clients' well-being according to the professional ethics of social work. However, the access by the clients can be limited when there is convincing evidence that access. to these records can cause serious harm. Derogatory communication can be used with respectful language to determine both the decisions made by the family and the client towards receiving any life-sustaining interventions. If their decisions are based on financial shortcomings, social workers should advise them and make sure the fee is pretty set and commensurate with the service in question. Step 8: Implementing the Action I would explain to Mr. Jenkins the limits of confidentiality and my duty to report any threats of harm to self or others, as stated in the NASW Code of Ethics and the Texas Social Work Practice Act (Barsky, 2017). I would ask Mr. Jenkins to tell me more about his plan to harm his partner and what led him to make this decision. I would listen to him empathically and non-judgmentally and try to understand his feelings, thoughts, and experiences. Validate Mr. Jenkins' emotions and strengths and acknowledge his challenges and stressors. I would also express my concern for his well-being, safety, and his partner's well-being and safety. Explore with Mr. Jenkins the consequences and implications of his plan and how it would affect him, his partner, and others. Ask him if he has any doubts or reservations about his project, hopes, or goals for his future. Help Mr. Jenkins to identify and evaluate other options that may resolve his conflict with his partner, such as communication, mediation, counseling, separation, or legal action. I would also help him to access the resources and supports that he needs, such as mental health services, domestic violence services, legal services, or social services. Seek Mr. Jenkins' consent to involve his partner or other supports, such as family, friends, or professionals, in the helping process. I would explain the benefits and risks of doing so and respect his decision. Document and report my actions and the outcomes of the intervention, and follow the ethical and legal guidelines for doing so. I would also seek consultation or supervision from my colleagues or supervisors and address any ethical issues or dilemmas that may arise. 7 8 00 Step 9: Achievement of Intended Outcomes To evaluate the process and results to determine if the intended outcome was achieved, I would use one of the evaluation methods in social work described in the web search results. Objectives. I need to do the following steps to evaluate the outcome or effectiveness. Collect and analyze the data before and after the intervention or the program and compare the changes in the indicators and criteria. Interpret and report the findings and draw conclusions and recommendations based on the evidence. Some of the data collection tools that I could use for an outcome or effectiveness evaluation are Surveys or questionnaires. These instruments ask standardized questions to the participants or the stakeholders of the intervention or the program and collect their responses in a quantitative or qualitative format. Surveys or questionnaires can measure the satisfaction, attitudes, opinions, or perceptions of the participants or the stakeholders, as well as the outcomes or impacts of the intervention or the program. Interviews or focus groups: These methods involve asking open-ended questions to the participants or the stakeholders of the intervention or the program and recording their responses in a verbal or written format. Interviews or focus groups can provide in-depth and detailed information about the experiences, feelings, thoughts, or behaviors of the participants or the stakeholders, as well as the strengths and weaknesses of the intervention or the program. Observations or assessments: These techniques involve observing or measuring the behaviors, skills, or performance of the participants or the stakeholders of the intervention or the program and recording them in a numerical or descriptive format. Observations or assessments can evaluate the changes or improvements in the abilities, functioning, or quality of life of the participants or the stakeholders, as well as the processes or activities of the intervention or the program. Issues Faced in Practice Finally, the use of the 9-step Ethical Decision-Making Model in Mr. Jenkins' situation emphasizes the significance of balancing autonomy and well-being. Social workers can make educated judgments that are compatible with professional values by examining specific ethical concepts and standards. Recognizing possible ethical quandaries in varied social work contexts also enables early planning. Understanding the strengths and weaknesses of ethical decision- making frameworks is critical for navigating complicated circumstances with integrity and responsibility. 9