Suicide: Duty of Care vs. Self-Care Social

Suicide: Duty of Care vs. Self-Care

Social Work and the Duty of Care

The social work profession aims at promoting social change, solving problems in human relationships, empowering and liberating individuals in order to enhance well-being (IFSW 2004). Social work intervenes at points where individuals interact with their respective environments through appropriate theories of human behavior and social systems. Principles of human rights and social are the fundamental guides of the practice and profession. Social workers are bound by these responsibilities in relation to the society and the people with whom they work (IFSW). The Australian Association of Social Workers now has a membership of 6,000 nationwide (AASW 2011). It is committed to the principles of justice, the enhancement of quality life and the realization of the full potential of every individual, group and community it serves (AASW).

American negligence law recognizes the duty of reasonable care of others in danger as a moral duty (Word Press 1988). It is also a legal duty if a special relationship between the parties. A court of law recognizes a therapist's duty to care and warn her patient of imminent harm on his life. This is comparable to a doctor warning a patient about a contagious or serious disease (Word Press).

Suicides and the Social Worker

A social worker's experience of seeing a client fall to his death through her office window in a building is not unusual. Suicide rates have gone up drastically in the last three decades, especially among adolescents and young adults (Rentsch 2011 p 2). Australia has among the highest rates of suicides in the world in the last 10-15 years. In response, the Commonwealth Government has allotted substantial funds for research, suicide prevention and support programs in the last 5 years. Nonetheless, suicide rates have remained high and this trend indicates a serious social problem. Current statistics say that more than 500 young people commit suicide every year. This means that there are more deaths from suicides than from road accidents and from drug overdoses. It implies a lack of meaning in life among these young people (Rentsch).

In 2008, the Australian Bureau of Statistics also noted an increased incidence of suicide and self-harm at 70% in aboriginal communities with a high level of mental problems and alcohol and substance use (Journalism Education Team 2009). Most of the fatalities were males. This high level of intentional self-harm or self-destruction indicates mental problems and community distress. Hospitalization correspondingly increases with the rise in incidence. Knowledge of the extent of suicides is, however, unknown because of limited official methods of collecting pertinent data. These limited data indicate that suicide is more frequent in the earlier adult years among this group of inhabitants than for other Australians (Journalism Education Team).

In Queensland, higher levels of suicides have been identified among certain population groups (Department of Communities 2008). These are young people, indigenous people, older people, those from culturally and linguistically diverse ethnic groups, people in custody, the mentally ill, and homosexual people. Certain factors also predispose individuals to suicide. These are social isolation, psychological or emotional conflict, poor health, life stresses, marriage troubles, unstable family environment, residence in a rural area, drug or alcohol problem, financial worries, abuse, interpersonal loss, financial disadvantage, job loss or some other traumatic event or experience (Department of Communities).

Laws in virtually every State specify that healthcare professionals have the duty to protect or warn persons of any form of impending violence (Striefel 2008). Violence includes client suicide or a threat of suicide. The duty of the healthcare professional, the social worker in this case, is to take reasonable steps to protect potential victims from potential perpetrators of violence. Her responsibility includes warning these potential victims, to hospitalize or secure the patient from the possible scene of violence. It may also include the revelation of confidential information in the interest of the potential victim. She must promptly conduct an evaluation of dangerousness by asking the potential victim about violent fantasies and the content of these fantasies. She should determine the quality of these fantasies, the person's preoccupation with them, his level of planning and the details of this plan, and any history of past suicidal behavior. She should check other factors, such as a loss of relationship, mood disorders, substance abuse, he person's level of distress and compulsiveness towards certain actions. The courts expect a social worker, as well as other health professionals, to capably predict the potential dangerousness or harm her client may impose on himself (Striefel).

The Ethical Climate of Social Care

Nurses and social workers are essential to the delivery of quality health care and its continuum (Ulrich et al. 2007). Complexities in the delivery have also introduced difficult ethical issues and situations in patient care. These complexities also limit these professionals respect in their work and induce job dissatisfaction. A recent study investigated 1,215 nurses and social workers in four census regions of the U.S. On ethical issues confronted at work. It found that almost 2/3 of the respondents expressed frustration and fatigue over some of ethical issues they could do nothing about (Ulrich et al.).

Those without institutional support for adequately handling these issues and stress were more likely to leave their jobs than those who did not confront the problem (Ulrich et al. 2007). Of the 25% who would like to leave their current jobs, most were young workers and those who worked full time. The frustration, fatigue, disrespect and dissatisfaction over their job lead them to consider the many opportunities available in the outside. Analysis showed that the quality of ethical climate determines the relationship between ethical stress and job satisfaction. Job satisfaction, on the other hand, completely mediates ethical stress and the intent to resign. Nurses and social workers who enjoy support and resources in the ethical issues they confront are likelier to endure the stress involved in ethical situations and remain satisfied in their jobs. Findings also revealed that nurses and social workers in hospital settings suffer more ethics stress than those in non-hospital settings. The volume of patients and the intensity of the ethical issues or situations, staffing levels, the size of the hospital, its location and organizational characteristics seem to explain the finding (Ulrich et al.).

Self-harm, a major social problem

Select social workers identified the top 5 social justice issues as diversity, child welfare, healthcare, poverty and social problems (Gutierrez & Abramovitz 2007). People who live in chronic deprivation or harsh living conditions feel insecure and powerless. Some of them cope with their situation or escape from it by harming themselves through suicide. Social workers have the training and professional obligation to help these individuals in their distress. A social worker does this by helping the individual change his negative coping behavior into a positive coping behavior. She does this helping him seek social, health, financial and social advocacy assistance (Gutierrez & Abramovitz).

Social workers realize that exposure to serious or extreme economic hardship and other adverse conditions often leads to a host of adverse individual and social problems rather than the reverse. Prevention and social change are called for (Gutierrez & Abramovitz).

Duty to Care vs. Duty to Self

The duty to provide or extend care draws from the principles of beneficence and non-maleficence (Schrocter 2008). Beneficence means to do good while non-maleficence means to do no harm. These outline the moral obligation of healthcare professionals in promoting the welfare, health and well-being of patients. Beneficence particularly grounds the patient-provider relationship. The duty to care emanates from the second provision of the American Nurses Association Code of Ethics, which states that the health professional's primary commitment is to the patient. The provision of care is interpreted as an ethical obligation. The fifth provision in the Code states that the nurse, or health professional, has as much duty to herself as to others. Moreover, there has been attention given to care for caregivers in discussions. The health professional is, thus, obligated to care for others and for herself as well (Schrocter).

These conflicting obligations become pronounced during times of disaster when health professionals are called to attend to critically ill or wounded patients for long durations (Schrocter 2008). These professionals must decide how much care to provide them and how much to keep for themselves. The real conflict is that ethical codes of professional service seem to be the norm in the eyes of the law. They become the basis of legal obligations and decisions in hard times such as these. Under the present healthcare system, the social contract between the health professional and society compels the professional to respond to the emergencies and disasters promptly and adequately. Society expects these professionals to be self-regulating in expecting huge mass casualties in cases of terrorist attacks and increasing natural disasters. In these times, present codes of ethics need to remain as they are in accordance with public expectations and changing professional environments (Schrocter).

Friends and family may be enlisted for self-care and self-protection for disaster preparedness (Schrocter 2008). However, there is real need for the expertise of healthcare providers in response to pandemics and disasters. No other segment of society can substitute for them. These healthcare professionals are expected to be well aware of the very high demand and very high-risk levels required of them in their specialty professions. This awareness, though, does not discount the need for them to care for themselves. Hospitals and other institutions where they work are also obliged to provide them safe working environments and conditions. But in times of disasters, resources run short. In many cases, these healthcare providers take in more risks than usual. They must choose between caring for others in adverse situations and their families or friends. They need to strike a balance and seek a basis from the code of ethics. This will make them more willing to and comfortable in providing care for others in emergency or more adverse situations (Schrocter).

While a health professional or social worker is well aware of their commitment to the public, she should also know what to do or not do in maintaining professional integrity (Schrocter 2008). This should be settled before disasters occur. Hospitals, managers, institutions, administrators and health professionals themselves must clearly know and understand what is justly expected of them in difficult times. They should be aware of whether they can commit to any level of care during times of adversity. They have the duty and right to protect their own right to self-preservation and self-care. Becoming members of a trauma team will orient them on their duty to care against their duty to self. Getting involved in disaster planning and preparedness committees, councils, and legislation lobbying are other ways of gaining important knowledge in the task. Both they and the public need to be better informed on what realistic expectations can be made on them. For their part, social workers need to reflect on their own values and integrity in ascertaining what is morally appropriate for themselves in times of emergency and disaster (Schrocter).

Professional Self-Care

Dorothea Orem's Self-Care Theory lists major assumptions (Current Nursing 2011). These are that people are self-reliant and responsible for their own care and those of their family who needs it; people are distinct individuals; nursing or care is an interaction between two or more persons; successfully meeting self-care requisites are basic to primary care prevention and ill health; knowledge of health problems promotes self-care; and self-care and dependent care are both learned within some socio-cultural context (Current Nursing). Some social workers recognize the importance of self-care but at times feel selfish when caring for themselves (Jones 2008). They need to think about older caregivers who neglect themselves and reach the time when they have to care for themselves. They will be helped in better ways if self-care is given the attention it need before they get to that point of not being able to give it to themselves because of age. Every health professional draws care from herself as the only vehicle. This makes self-care her basic responsibility. Tending to one's care will turn out to be a privilege in her career of caring for clients (Jones).