Discussion Prompt
John R. is a 54-year-old patient who has been diagnosed with schizo-affective disorder. John’s mental illness status has prevented him from holding a full time job, though he he has been married to the same woman for over 15 years. John’s family is wealthy and has provided for John and his wife, but he recently engaged in unsafe activities that resulted in him squandering a large sum of money. His family has insisted that he participate in a program at a private psychiatric facility that focuses on a harm reduction model. John has rejected medication in the past, but takes psychotropic drugs from time to time until he decides to withdraw from his medication due to unwelcome side effects.
John has been in the program for over a year and his individual counseling, together with group therapy, has produced substantially positive results until recently when John had a violent altercation with one of the other participants in the program. It was the first time that John had exhibited any violent symptoms, but the outburst led to his being hospitalized for several weeks.
While his main therapist visited him in the hospital, John revealed that he was not taking his medication, but holding it in his cheek until the nurses had gone. His therapist is concerned because he knows that compliance with medication will be one of the criteria for John being accepted back into the program.
The therapist’s dilemma is whether to risk the trust and confidence that has been built with John over time, or to reveal John’s actions, which could potentially destroy their therapeutic alliance or try to ensure that John returns to the program and receives the help that he needs in a supportive environment.
For your original post, answer the following questions:
Imagine you are John’s therapist—How do you begin to think about this ethical dilemma? What are the social work values (see: Code of Ethics) and the moral principles (Respect for Autonomy, Beneficence, Non-Maleficence, or Justice)?
Which principle would be most important in this case, and why?
How would you resolve the dilemma?
How would you feel as a result of the resolution (moral traces)?
Citations for sources and sources to use
• NLASW Professional Issues Committee.
(2015). Ethical decision-making in
social work practice.
NASW Code of Ethics, revised 2021.
https://www.socialworkers.org/About/
Ethics/Code-of-Ethics/Code-of-
Ethics-English
Wharton, T. C. (2019). Compassion fatigue: Being an ethical social worker. The New Social
Worker. https://www.socialworker.com
/feature-articles/ ethics-
articles/Compassion_Fatigue%3A_Bei
ng_an_Ethical_Social_Worker/
