Inclusive Model Of Ethical Decision Making
Introduction Social work practice is not without its human rights, ethical and legal contexts and issues and effectively working with them is pivotal to safe and empowering practice. This practice includes creating appropriate and extensive care plans, which work with the available resources and exhibit understanding of the contexts and issues. Daniel aged 20 has presented at Golden City Psychiatric Services in Bendigo in his first admission in a very depressed and uncommunicative state. The ethical dilemma for Daniel using the ‘Inclusive Model of Ethical Decision Making’ (Chenoweth & McAuliffe, 2015) which encompasses all contexts is his capacity to give consent and the conflicting best interests of his parents. This has been presented through
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lacking insight into himself, including his behaviour and elder abuse allegations. Daniel’s family has tensions over Daniels return to the community as he was living with his elderly parents who still feel an obligation to look after him and his increasing needs, while his siblings have alleged elder abuse by him which his parents deny. An ethical model and principles can be methodical. This is complimented with the application of relevant laws and legal systems, followed by the ethical decision model, which creates the care plan and concluded with the critical reflection into the personal and professional outlook and possible improvement areas in both.
Ethical principles and Human Rights Social work practice is influenced by ethics and human rights but also values which can be ethical also, 2 of social works most integral ethics values are respect for persons and social justice (AASW, 2010). Creating the social work role of empowering Daniel to make and enact his only choices but also advocate to reduce or remove mental illness stigma (AASW, 2014). This role can be changed with the possibility of involuntary treatment or community treatment order as this can limit the self-determination of Daniel and change the choice Daniel has in his life impacting the treatment he receives may violate his human rights such as the ‘protection from inhumane and degrading treatment’(Charter of Human Rights and Responsibilities, 2006, s.10), as a practitioner may view one treatment or the forcing of treatment necessary in his best interests medical but not emotionally and cause a human right violation (Brophy, Campbell & Healy, 2003). Social workers must always stay advocators as laws do promote disempowerment and social workers must still work within these laws but must strive to change them (AASW, 2010; Brophy, Campbell & Healy, 2003). Due to the nature of this referral Daniels parents are include as it is considered that Daniel is a burden on his parents and may be abusing them, thus requiring for Daniel to leave their residence for their safety. This presents the same ethical principles Daniel is facing as the parents respect for persons and social justice works within their self-determination for Daniel to return to their care and have the shame of elder abuse advocated for to reduce or remove its happening (AASW, 2010). Due to the confliction nature of this the AASW (2010), requires social workers to work with strict clarification of their role and if this is not possible to remove themselves through termination or referral. The ethical role the social worker can do to reduce this conflict of interest is to thoroughly investigate the allegations of elder abuse with relevant authorities, and work with the outcome advocating for their familial relationship and Daniels mental illness, and also ensuring the safety of all (AASW, 2010, 2014; Rice & Day, 2014). Another pressing ethical dilemma is the vague assessment of Daniels capacity to give consent. Daniel is competent to understanding information but lacks insight into his contexts and needs and is relying on his parents to continually support his needs despite the ailing capacity to continue caring. The AASW (2010) does stipulate information being presented in individualist ways, but Daniel does not lack processing the information, but lacks insight which is not within the code of ethics. Due to Daniel lacking insight he may be brought before an mental health tribunal under the Mental Health Act (2014) and as his lack of insight maybe interpreted as a serve mental illness and due to insight being such an abstract concept Daniel may not be within healthy capacity to learn it and the constraints on the health may pressure a faster resolution to consent issues, through an community treatment order and preventing Daniel self-determination (Brophy & Mcdermott, 2013; O'Neill, & Carmelle, 2011; AASW, 2010; Brophy, Campbell & Healy, 2003).
Law and Legal Systems Social workers practice within contextually based legislation and universal legalisation.
Universal legalisation includes duty of care under the Wrongs and Other Acts (Law of Negligence) Act (2003) and the Charter of Human Rights and Responsibilities Act (2006). Contextually based legislation for Daniel is the Mental Health Act (2014) and the Guardianship and Administration Act (1986), with the Disability Act (2006) supplementing the Guardianship and Administration Act (1986). The Charter of Human Rights and Responsibilities Act (2006), as previously discussed protects Daniel in a number of ways but especially ‘recognition of equality before the law’ (s.8), ‘protection from …inhumane and degrading treatment’ (s.10) and ‘humane treatment when deprived of liberty’ (s.22) (Fitzroy Legal Service, 2016). Daniel is through for protected against harm, stigma and discrimination practically from practitioners. The Mental Health Act (2014) regulates many aspects of mental health treatment including voluntary and involuntary treatment, assessment requirements, allowable treatments, medications and complaints. For Daniel this act will be working with him for most if not all of his life and he will require a lot of support from it, as it does with outlining his rights and the procedures to uphold his rights. The act also has within it disempowering aspects to it such as assessments which could reduce Daniels rights and choices (Chenoweth & McAuliffe, 2015; Fitzroy Legal Service, 2016; Brophy & Mcdermott, 2013; Brophy, Campbell & Healy, 2003). The Guardianship and Administration Act (1986), with the Disability Act (2006) supplementing is there if the capacity of Daniel goes to VCAT, and thus Daniel will need to be proven incompetent and with mental health related disability, as the Guardianship and Administration Act (1986), stipulates the powers and legality of guardians and the process in which the guardianship can be made and the disability act defines disability and
gives protection to those with a disability. The office of the public advocate will be of much use to Daniel as it can help prevent the guardianship if he so wishes it to, investigate family issues on behalf of VCAT, this can also help resolve the allegations of elder abuse and the parents capacity to care for Daniel, give Daniel more options with his legal situation and regulate and monitor his guardian if it is not them, they can also advocate for Daniel within the mental health services he uses ( Office of the Public Advocate, 2016a, 2016b). It may also be beneficial for both Daniel and his parents to involve a public advocate now to reduce the possibility of Daniel’s self-determination and autonomy being disrespected.
An Ethical Decision-Making Model and Care Plan The Inclusive Ethical Decision Making Model of Chenoweth & McAuliffe (2015) seen in Appendix A, has been developed to uphold social work and legal principles and create a system for improvement on the systems that already exist. The model works by first having dimensions which need to be accounted for in each step; accountability, critical reflection, cultural sensitivity and consultation. These dimensions encourage exploration, inclusion and change, as well as making sure the social worker is working within each step ethically. The steps are firstly defining the ethical dilemma, which encompass not only the information at hand but also the social workers knowledge, skills and scope of practice. Daniels ethical dilemma is that his capacity to give consent is contested with a vague assessment, which is exacerbated by family issues of the parent’s capacity to care for Daniel and the allegations against Daniel for elder abuse. This is followed by mapping legitimacy, works with finding the stakeholders within the situation and the validity of their input into the decision process such as with Daniel it is not essential to involve his treatment team as they information they can provide was within the referral, but it is necessary to involve his family as not including may cause for non-ethical decision making due to their heavy involvement in Daniel’s now due to him living with his parents and the loss of his circle of friends due to his depressive states preventing him from leaving the house. Gathering information them follows as with ethical social work practice evidence is always required for any type of intervention (Chenoweth & McAuliffe, 2015). Alternate approaches and action comes next, this explores what are the most feasible actions, other alternatives and what could possible happen is they are implemented, these actions are outlined in Appendix B, there are only two options due to Daniels capacity to give consent to most overarching issue, which does questions his understanding of his best interests and the context of his situation. His parents are also outlined within this dilemma as his best interests may cause them harm, so their best interests also need to be accounted for. And with the Victorian and Australian legal system to be within unknown capacity is to not be treated and left in limbo, so Daniel either needs to be competent or not, and assigned someone who can be on his behalf (Chenoweth & McAuliffe 2015; O'Neill, & Carmelle, 2011). Critical reflection and evolution is the final step in this process, which can also be a cycle in some cases will be further explored later in this essay. For Daniel a care plan should include his family and relevant legal services. So the Golden City Psychiatric Services team working with him will need to be include for their treatments both short and long term to be accounted for and other possible inclusion of services in the near future from the few in the surrounding areas. Due to Bendigo being regional it has been group with a large area known as the Loddon Campaspe and Southern Mallee area and thus the mental health services are spread out and in main towns and centres; http://www.health.vic.gov.au/mentalhealthservices/adult/loddon-a.htm. Daniel may also greatly benefit from having from the outset a plan to return to the community and thus services such as Bendigo Adult PARC, operated by Mind Australia (2016) or Bendigo Adult Community Mental Health Team operated by Bendigo Health (2013) could offer Daniel or his guardian options into his care in the community. A previously mentioned a public advocate could greatly benefit Daniel and help relieve his parents of pressure to do with his treatment in care and future treatments (Office of the Public Advocate, 2016b).
Critical Reflection In Daniels progress for improvement in his mental health there are a number of barriers. One of the main barriers is his regional setting which limits his choice due to the few services available and this may also impact on the quality of the service, as it may require waitlists or be unsuitable for Daniel (Chenoweth & McAuliffe, 2015). Daniel may also be resistant to services or treatment which could result as previously discussed with a community treatment order which can negatively impact Daniel and change his care plan dramatically, as well as over medicalize his situation leaving his autonomy and self-determination disrespected, and emotional wellbeing in a poor state further isolating him (Brophy & Mcdermott, 2013; Brophy, Campbell & Healy, 2003). Further constraints for disempowerment are the legal system, organisational context and scope of practice for social workers as legislation can promote the forcing of treatment as well as organisational policy and procedure using the legal system to ensure and support their practice without consideration for the ethics of self-determination, dignity of risk and autonomy (Brophy & Mcdermott, 2013; Brophy, Campbell & Healy, 2003). The limitations is also on the social worker due to them having to refer to different services for complete and ethical practice which can also impede of Daniels situation through confusion, waitlists and the services not complementing each other (Rice & Day, 2014; Brophy & Mcdermott, 2013; Brophy, Campbell & Healy, 2003). As a social worker I will need to be aware of these issues to practice to ensure that work with them as legally and ethical as possible, and help advocate to change them to make more ethical and cohesive practice as a social worker and with services and being aware of the mental health system being so complex that many despair at using it.
Conclusion
The ethical and legal practice of social within Daniels situation is complex and does require a comprehensive model to work within. This model needs to include acknowledgement for mental health and family issues as well as the individual, while promoting self-determination and autonomy simultaneously. Though the model used in this essay was ethical it still needs improvements through advocacy of the mental health and legal systems for the vulnerable as it is so complex and the vulnerable are easily left behind, as Daniel and his family could be, as they were only given two options due to the legal system.
lacking insight into himself, including his behaviour and elder abuse allegations. Daniel’s family has tensions over Daniels return to the community as he was living with his elderly parents who still feel an obligation to look after him and his increasing needs, while his siblings have alleged elder abuse by him which his parents deny. An ethical model and principles can be methodical. This is complimented with the application of relevant laws and legal systems, followed by the ethical decision model, which creates the care plan and concluded with the critical reflection into the personal and professional outlook and possible improvement areas in both.
Ethical principles and Human Rights Social work practice is influenced by ethics and human rights but also values which can be ethical also, 2 of social works most integral ethics values are respect for persons and social justice (AASW, 2010). Creating the social work role of empowering Daniel to make and enact his only choices but also advocate to reduce or remove mental illness stigma (AASW, 2014). This role can be changed with the possibility of involuntary treatment or community treatment order as this can limit the self-determination of Daniel and change the choice Daniel has in his life impacting the treatment he receives may violate his human rights such as the ‘protection from inhumane and degrading treatment’(Charter of Human Rights and Responsibilities, 2006, s.10), as a practitioner may view one treatment or the forcing of treatment necessary in his best interests medical but not emotionally and cause a human right violation (Brophy, Campbell & Healy, 2003). Social workers must always stay advocators as laws do promote disempowerment and social workers must still work within these laws but must strive to change them (AASW, 2010; Brophy, Campbell & Healy, 2003). Due to the nature of this referral Daniels parents are include as it is considered that Daniel is a burden on his parents and may be abusing them, thus requiring for Daniel to leave their residence for their safety. This presents the same ethical principles Daniel is facing as the parents respect for persons and social justice works within their self-determination for Daniel to return to their care and have the shame of elder abuse advocated for to reduce or remove its happening (AASW, 2010). Due to the confliction nature of this the AASW (2010), requires social workers to work with strict clarification of their role and if this is not possible to remove themselves through termination or referral. The ethical role the social worker can do to reduce this conflict of interest is to thoroughly investigate the allegations of elder abuse with relevant authorities, and work with the outcome advocating for their familial relationship and Daniels mental illness, and also ensuring the safety of all (AASW, 2010, 2014; Rice & Day, 2014). Another pressing ethical dilemma is the vague assessment of Daniels capacity to give consent. Daniel is competent to understanding information but lacks insight into his contexts and needs and is relying on his parents to continually support his needs despite the ailing capacity to continue caring. The AASW (2010) does stipulate information being presented in individualist ways, but Daniel does not lack processing the information, but lacks insight which is not within the code of ethics. Due to Daniel lacking insight he may be brought before an mental health tribunal under the Mental Health Act (2014) and as his lack of insight maybe interpreted as a serve mental illness and due to insight being such an abstract concept Daniel may not be within healthy capacity to learn it and the constraints on the health may pressure a faster resolution to consent issues, through an community treatment order and preventing Daniel self-determination (Brophy & Mcdermott, 2013; O'Neill, & Carmelle, 2011; AASW, 2010; Brophy, Campbell & Healy, 2003).
Law and Legal Systems Social workers practice within contextually based legislation and universal legalisation.
Universal legalisation includes duty of care under the Wrongs and Other Acts (Law of Negligence) Act (2003) and the Charter of Human Rights and Responsibilities Act (2006). Contextually based legislation for Daniel is the Mental Health Act (2014) and the Guardianship and Administration Act (1986), with the Disability Act (2006) supplementing the Guardianship and Administration Act (1986). The Charter of Human Rights and Responsibilities Act (2006), as previously discussed protects Daniel in a number of ways but especially ‘recognition of equality before the law’ (s.8), ‘protection from …inhumane and degrading treatment’ (s.10) and ‘humane treatment when deprived of liberty’ (s.22) (Fitzroy Legal Service, 2016). Daniel is through for protected against harm, stigma and discrimination practically from practitioners. The Mental Health Act (2014) regulates many aspects of mental health treatment including voluntary and involuntary treatment, assessment requirements, allowable treatments, medications and complaints. For Daniel this act will be working with him for most if not all of his life and he will require a lot of support from it, as it does with outlining his rights and the procedures to uphold his rights. The act also has within it disempowering aspects to it such as assessments which could reduce Daniels rights and choices (Chenoweth & McAuliffe, 2015; Fitzroy Legal Service, 2016; Brophy & Mcdermott, 2013; Brophy, Campbell & Healy, 2003). The Guardianship and Administration Act (1986), with the Disability Act (2006) supplementing is there if the capacity of Daniel goes to VCAT, and thus Daniel will need to be proven incompetent and with mental health related disability, as the Guardianship and Administration Act (1986), stipulates the powers and legality of guardians and the process in which the guardianship can be made and the disability act defines disability and
gives protection to those with a disability. The office of the public advocate will be of much use to Daniel as it can help prevent the guardianship if he so wishes it to, investigate family issues on behalf of VCAT, this can also help resolve the allegations of elder abuse and the parents capacity to care for Daniel, give Daniel more options with his legal situation and regulate and monitor his guardian if it is not them, they can also advocate for Daniel within the mental health services he uses ( Office of the Public Advocate, 2016a, 2016b). It may also be beneficial for both Daniel and his parents to involve a public advocate now to reduce the possibility of Daniel’s self-determination and autonomy being disrespected.
An Ethical Decision-Making Model and Care Plan The Inclusive Ethical Decision Making Model of Chenoweth & McAuliffe (2015) seen in Appendix A, has been developed to uphold social work and legal principles and create a system for improvement on the systems that already exist. The model works by first having dimensions which need to be accounted for in each step; accountability, critical reflection, cultural sensitivity and consultation. These dimensions encourage exploration, inclusion and change, as well as making sure the social worker is working within each step ethically. The steps are firstly defining the ethical dilemma, which encompass not only the information at hand but also the social workers knowledge, skills and scope of practice. Daniels ethical dilemma is that his capacity to give consent is contested with a vague assessment, which is exacerbated by family issues of the parent’s capacity to care for Daniel and the allegations against Daniel for elder abuse. This is followed by mapping legitimacy, works with finding the stakeholders within the situation and the validity of their input into the decision process such as with Daniel it is not essential to involve his treatment team as they information they can provide was within the referral, but it is necessary to involve his family as not including may cause for non-ethical decision making due to their heavy involvement in Daniel’s now due to him living with his parents and the loss of his circle of friends due to his depressive states preventing him from leaving the house. Gathering information them follows as with ethical social work practice evidence is always required for any type of intervention (Chenoweth & McAuliffe, 2015). Alternate approaches and action comes next, this explores what are the most feasible actions, other alternatives and what could possible happen is they are implemented, these actions are outlined in Appendix B, there are only two options due to Daniels capacity to give consent to most overarching issue, which does questions his understanding of his best interests and the context of his situation. His parents are also outlined within this dilemma as his best interests may cause them harm, so their best interests also need to be accounted for. And with the Victorian and Australian legal system to be within unknown capacity is to not be treated and left in limbo, so Daniel either needs to be competent or not, and assigned someone who can be on his behalf (Chenoweth & McAuliffe 2015; O'Neill, & Carmelle, 2011). Critical reflection and evolution is the final step in this process, which can also be a cycle in some cases will be further explored later in this essay. For Daniel a care plan should include his family and relevant legal services. So the Golden City Psychiatric Services team working with him will need to be include for their treatments both short and long term to be accounted for and other possible inclusion of services in the near future from the few in the surrounding areas. Due to Bendigo being regional it has been group with a large area known as the Loddon Campaspe and Southern Mallee area and thus the mental health services are spread out and in main towns and centres; http://www.health.vic.gov.au/mentalhealthservices/adult/loddon-a.htm. Daniel may also greatly benefit from having from the outset a plan to return to the community and thus services such as Bendigo Adult PARC, operated by Mind Australia (2016) or Bendigo Adult Community Mental Health Team operated by Bendigo Health (2013) could offer Daniel or his guardian options into his care in the community. A previously mentioned a public advocate could greatly benefit Daniel and help relieve his parents of pressure to do with his treatment in care and future treatments (Office of the Public Advocate, 2016b).
Critical Reflection In Daniels progress for improvement in his mental health there are a number of barriers. One of the main barriers is his regional setting which limits his choice due to the few services available and this may also impact on the quality of the service, as it may require waitlists or be unsuitable for Daniel (Chenoweth & McAuliffe, 2015). Daniel may also be resistant to services or treatment which could result as previously discussed with a community treatment order which can negatively impact Daniel and change his care plan dramatically, as well as over medicalize his situation leaving his autonomy and self-determination disrespected, and emotional wellbeing in a poor state further isolating him (Brophy & Mcdermott, 2013; Brophy, Campbell & Healy, 2003). Further constraints for disempowerment are the legal system, organisational context and scope of practice for social workers as legislation can promote the forcing of treatment as well as organisational policy and procedure using the legal system to ensure and support their practice without consideration for the ethics of self-determination, dignity of risk and autonomy (Brophy & Mcdermott, 2013; Brophy, Campbell & Healy, 2003). The limitations is also on the social worker due to them having to refer to different services for complete and ethical practice which can also impede of Daniels situation through confusion, waitlists and the services not complementing each other (Rice & Day, 2014; Brophy & Mcdermott, 2013; Brophy, Campbell & Healy, 2003). As a social worker I will need to be aware of these issues to practice to ensure that work with them as legally and ethical as possible, and help advocate to change them to make more ethical and cohesive practice as a social worker and with services and being aware of the mental health system being so complex that many despair at using it.
Conclusion
The ethical and legal practice of social within Daniels situation is complex and does require a comprehensive model to work within. This model needs to include acknowledgement for mental health and family issues as well as the individual, while promoting self-determination and autonomy simultaneously. Though the model used in this essay was ethical it still needs improvements through advocacy of the mental health and legal systems for the vulnerable as it is so complex and the vulnerable are easily left behind, as Daniel and his family could be, as they were only given two options due to the legal system.