Discussion Prompt
The following is a case that highlights a conflict between two professional values.
Ms. A. is a 60-year-old single woman with renal disease and early onset Alzheimer’s that required her to receive dialysis twice weekly and take numerous debilitating medications that often left her weak and unable to leave the house for days at a time. She lived in the house where she had grown up, with her father, until he passed away. The house, in a predominantly Irish-American working-class neighborhood, was several miles from the nearest town, and Ms. A. had no car or means of transportation. She had relied on neighbors while her father was alive, but many of those neighbors were also elderly and moved out of the neighborhood. She had strong emotional and cultural ties to the community which was part of the fabric of her cultural identity as an Irish-American. The Church and its pastor were important parts of her spiritual affiliation and even if she could not attend church services, she was calmed by their presence for her, should the need arise. When her father became ill and died, she told her brother that she wished to remain in the house until she passed away as well.
Her brother considered a nursing home to be the best alternative for her but said: “Because of everything she has done for our father, we will not push her too hard. She can have it her way!” Ms. A.’s general practitioner, who made regular home visits, monitored the effects of the dialysis and the dementia medication and had concluded, until now, that Ms. A. was mentally competent to decide where she wished to live.
Home nurses visited her three times a day and a home help aide came twice weekly to help with housecleaning, laundry, and grocery shopping, and to take her to dialysis. She received meals-on-wheels three days a week. When able, she enjoyed attending a local day care center where she had a small group of friends. She attended memory classes and painting classes. Once a week, a friendly visitor came and they played cards and talked. She had monthly visits from a social worker from the Alzheimer’s Association, who had been assigned to monitor Ms. A.’s status and ability to function in the home.
Her brother phoned her to remind her of which days she was to attend day care center, took care of her financial affairs, and arranged for a gardener and for the friendly visitor to take her to the hair salon twice a month. The social worker had regular meetings with Ms. A. and her family so that they could discuss her status and whether she required additional levels of care.
The social worker was concerned about safely issues and arranged for technical devices to be installed. Ms. A. had recently fallen several times and was unable to get up. She received an alarm button to summon help. Sometimes she forgot to turn off the coffee pot, so they installed a new one that automatically turned off after a certain length of time, minimizing the fire hazard. She used to lock her front-door with a chain because she felt safer, but the professional caregiver had this removed in spite of her protests. In case of her falling again or the possibility of fire, helpers needed to be able to enter the house.
Ms. A. continued to decline over the next months and the social worker was confronted with the dilemma of whether or not to recommend that Ms. A. leave her home and go to a nursing facility.
For your original post, answer the following questions:
What were the two professional moral principles that were in conflict? Please state this in a few sentences and specify the two competing choices facing the social worker.
What were the prima facie duties?
How does the social worker begin to make a decision about Ms. A.?
If you were the social worker, would you have any personal versus professional value conflicts? Please specify what they are and how you would negotiate which value took precedence. Use the literature where applicable.
Please use source provided and following citation
Abramson, M. (1985). The autonomy-paternalism dilemma in social work practice. Social Casework, 66(7), 387-393.
