What are the ethical considerations here? What process might you use to make ethical decisions here (consider legal, ethical, and organisational)?

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Ethical I

You are a specialised social worker at a large tertiary public hospital and you work with women who experience unplanned pregnancies and are considering their options: continuing the pregnancy, terminating the pregnancy or adoption.  You provide intake, assessment, counselling, advocacy and support services to women.

You are called by the hospital staff to see a woman, Debbie, lives in regional Victoria, and who is fifteen weeks pregnant and who has been admitted to a hospital ward overnight after she was admitted to hospital after excessive drug and alcohol consumption that has caused her to become very unwell.  The hospital staff tells you they have concerns for the health and viability of the foetus due to the drug and alcohol use during pregnancy.  They tell you that they have previously worked with Debbie (these notes are in her hospital file) who has a long history of poly-drug and alcohol use, and a complex history of her own childhood abuse as well as having been the victim of domestic violence from multiple partners as an adult.  Debbie has four children, none of whom are in her care, and has mentioned the idea of having an abortion but is also stating she will not do this as it is against her belief systems to have an abortion and that ‘every child should have a right to be born’, and also because she believes that Child Protection services are pressuring her to have an abortion.  The hospital staff are concerned that if Debbie continues the pregnancy the child will suffer severe medical issues including brain damage from foetal alcohol syndrome and have discussed this with the relevant specialists.  The staff ask you for your assessment of ‘what  Debbie wants’  as well as discussing the need for urgent ante-natal care for Debbie, and of the need for available abortion services for Debbie as a back-up.  They also tell you that Debbie has a history of absconding from the hospital, and failing to turn up to booked appointments.

When you sit with Debbie and being discussing the issues with her as she sees them, she tells you of her history of violence from multiple partners, including the father of this pregnancy. Debbie tells you she has just come out of refuge due to the violence experienced from this partner, however that she would like to ‘have this baby’ and give it to her partner because ‘he’s had a hard life’ and ‘might be a good father’.  Debbie discusses in detail her experience of having a previous abortion into which she was forced by a partner, and how this was traumatic for her and that she couldn’t do it again.  She tells you that she has had a long relationship with Child Protection and that she ‘hates them’ as they have always punished her for the family violence she has experienced from partners.  She tells you she is very angry at the pressure from Child Protection for her to have an abortion and that she ‘might as well have another child’ in this context. Debbie then mentions that she might actually need to have the abortion ‘sooner than later’ as is not sure if her partner, who has a new girlfriend now, will ‘take the baby’ and ‘if he doesn’t, then (I) will probably abort’. 

Debbie asks you to hold her abortion appointment for another week so she can consider what to do.

You are aware that the only available public (free) abortion services that exist in the state must see Debbie before another week passes or she would be too late to access an abortion there.  You are aware that there are many other women who are also hoping to access the same limited appointments that Debbie wants. They also experience similarly difficult situations to Debbie, including being victim/survivors of violence, homelessness, and mental health issues and that they won’t be all able to get a service.

What are the ethical considerations here?  What process might you use to make ethical decisions here? (Consider legal, ethical, and organisational)?

Ethical II

You are a social worker in a sexual assault service. You have been working with a service-user for over a year as a counsellor with a male client aged 45, Errol, who has a history of post-traumatic stress disorder (PTSD) due to multiple and prolonged childhood sexual assault by a trusted adult.  Errol also sees his GP for anxiety medication and his GP is aware of Errol’s PTSD and history of trauma. This is the first time Errol has ever seen a counsellor longer than two months as has a history of ‘never going back’ after the first session.

Throughout the counselling many of the issues that you have been working through with Errol are related to his social isolation, due to his inability to trust others, related to the violations of trust he experienced a child.

It has taken a long time, but in the last six months, Errol has begun to trust you more in the counselling sessions, and has begun to attend appointments regularly rather than sporadically, and even states that he looks forwards to his regular contact with you.  

IN the past two weeks, Errol confides in you that it was it at his his sixth birthday party that the abuse began to happen and so every year around his birthday, he notices that his PTSD symptoms become more pronounced and that he seems to isolate himself more, due to the severity of the symptoms and his feelings of being ‘out of control’ and ‘in danger’.  One of the things that Errol discusses in this context is that all his life he has felt ‘out of control’ and relates this to the experience of the abuse where he could have ‘no control’ over what happened to him. One of his goals in therapy is to regain a sense of control in his life.

During the week leading up to Errol’s 46th birthday, Errol phones you one afternoon and is clearly in a distressed and agitated state.  Errol tells you how he has been having intrusive flashbacks of the abuse, night after night this week, and that he feels so bad he wishes he could die.  You conduct a suicide risk assessment with Errol and he confides that he does have a lot of sedative medication at home and has thought seriously about taking it to ‘end the suffering’ and that he cannot see himself getting through tonight without acting on this. 

You talk to Errol about your concern for him and his safety and your wish to discuss ways you could help Errol to plan to get through tonight without acting on his suicidal thoughts. You make some suggestions such as calling his GP, calling an ambulance or contacting one of his friends. However, you are worried when Errol refuses to discuss any of these options and forbids you to contact his GP, ambulance or friend and accuses you of ‘trying to control his life just like the others’.  Errol tells you that if you break his privacy by telling others what he has just told you that he ‘won’t ever be able to trust you again’ and then he hangs up the phone.  You try to call Errol back but the phone is switched off.

What are the ethical considerations here?  What process might you use to make ethical decisions here (consider legal, ethical, and organisational)?

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