Informed Consent and Confidentiality

Competence refers to the practitioner's accurate self-representation of credentials as well as contributing to the profession by undergoing ongoing professional development throughout the career. Although competence is a distinct value from integrity, it is also related to integrity because all social workers should have the personal and professional integrity to practice only within their realm of professional training and competence, and also to upgrade their skills according to emerging research, theory, and policy. The NASW (n.d.) also points out in its Code of Ethics that competence is integral to the protection of clients from harm (p. 2). Informed consent, although a distinct ethical practice, is linked to professional competence in several ways. According to the NASW (n.d.), "social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent," (1.03). Informed consent promotes respect for clients as well as client autonomy, and informed consent also protects clients from harm. Both informed consent and competence are covered under the rubric of social workers' ethical responsibilities to clients.

Informed consent and competence are both ethical responsibilities to clients because both provide clients with the knowledge and power they need to make educated decisions. Competence ensures that the client is receiving information from the best possible source, and informed consent ensures that the client has received all information accurately and is not being deceived in any way. When a social worker is working with "an emerging area of practice," for which "no generally recognized standards exist," the professional and ethical obligation to the client remains full disclosure as well as acquiring either research or supervision to protect the client from harm (NASW, n.d., 1.04). Both informed consent and competence protect clients by ensuring clients have access to any and all information relevant to their case and their needs, ensuring also that the social worker will have the ethical judgment to refer the client to additional services or information when necessary.

2. The Dutch euthanasia law is progressive and responsible. Although it is a controversial issue, I do believe that assisted suicides in cases like that of Mark Langedijk are morally and ethically permissible from several principles. For one, the Dutch system ensures that a physician presides over each case and did so in Langedijk's case. "His death was approved by a doctor from Support and Consultation on Euthanasia in the Netherlands, a medical body that oversees requests from those who wish to die with the help of the state," (Richardson, 2016, p. 1). The assurance of competence from an established medical board and competent physicians ensures that the process of euthanasia occurs with rigorous clinical oversight and good professional -- as well as ethical -- judgment. Informed consent is built into the system, as the patient must initiate the euthanasia request in cases like that of Langedijk. The most important elements of the Langedijk case that highlights the ethical tenets of a liberal euthanasia policy is patient autonomy, self-determination, and freedom. A patient does have the right to "die with dignity," in a manner according to his or her will, especially when a presiding physician has determined that the case clearly warrants compassionate intervention. Moreover, the liberal approach to euthanasia exemplified by the Dutch does reduce medical paternalism, which interferes with patient autonomy. I do not believe that the Langedijk case is appreciably different from that of Sandy Bem. Both underwent extensive suffering in their lives and both made their decision in the absence of any coercion. As Henig notes, it was "plain that her death was her decision alone," (p. 18). Langedijk was "in and out of rehab 21 times to try to treat his battle with alcohol," and yet opponents of the Dutch law have ironically claimed, "What someone suffering from alcoholism needs is support and treatment to get better from their addiction -- which can be provided -- not to be euthanised," (Richardson, 2016). The former comment epitomizes medical paternalism.

3. Confidentiality is covered extensively in the NASW Code of Ethics, as it applies to different types of situations and relationships, in Section 1.07. There are a few instances in which a social worker may breach confidentiality. The NASW uses the phrase "except for compelling professional reasons," such as "when disclosure is necessary to prevent serious, foreseeable, and immanent harm to a client or other identifiable person," (NASW, n.d., 1.07). Even when a social worker may be ethically obligated to breach confidentiality in these types of extreme situations, the "least amount of confidential information" should be released -- only that which is relevant to the purpose at hand (NASW, n.d 1.07). Informed consent also comes into play with confidentiality, because the social worker is obliged to inform the client about when a breach of confidentiality might take place. The client must authorize any other information disclosures.

The NASW (n.d.) does an excellent job covering the multiple parameters of confidentiality, and it is one of the longest sections in the code of ethics. For example, the NASW (n.d.) specifically mentions avoiding talking about clients in public spaces including "hallways, waiting rooms, elevators, and restaurants," (1.07, i). Moreover, the NASW (n.d.) urges social workers to do their best to protect client confidentiality even when they are testifying in court. Social workers should not feel pressured to divulge any more than they need to under the provisions of the law.

4. (a) I do believe Phan has the right to confidentiality and that the social worker needs to proceed with caution instead of alarmism or paternalism. To genuinely protect Phan, the social worker can coax him into using safe sex until the underlying issues are brought to the surface.

(b) Processing Phan through the Department of Community-Based Services would be detrimental to him and also to his mother and would absolutely violate the Do Not Deprive of Freedom ethical precept. Reporting Phan does nothing to help him. His mother is not neglecting him; she works three jobs and is doing the best she can to support herself and her son. The problem needs to be contextualized. Issues related to gender, ethnicity, and systematic discrimination are the real problems. The school also needs to be brought into the discussion. Phan will benefit from systematic counseling and targeted interventions that help both him and his mother. The social worker needs to prevent Phan from being institutionalized, while protecting him and preventing his behavior from getting out of hand.

(c) The NASW (n.d) recommends caution when it comes to breaching confidentiality. According to the Code of Ethics, the social worker is obligated in this case to inform Phan of his rights, which means telling Phan that if his behavior does continue to get riskier, that the chances of reporting him may increase because his safety is the social worker's responsibility.

5. (a) I am responsible as much to Phan's mother as to Phan, partly because Phan is under age and his mother is his legal guardian but also because Phan's problems are also her problems, and vice-versa. Phan's mother is as much my client as he is. Involving Phan's mother in the process of social work is integral to the core principles of our profession.

(b) The ethical principle of Social Justice guides my decision in how to proceed with Phan. Phan's case highlights issues like discrimination and poverty among disenfranchised groups. Similarly, my willingness to keep quiet at first and protect Phan's confidentiality until the time is right reflects the value of Dignity and Worth of the Person. I also value Phan's mother's Dignity and Worth, which is why I need to create a situation where Phan feels safe in the social work setting, completely trusting that telling his mother is for his own long-term best interest -- as well as hers. Finally, I will also act in accordance with the principles of Integrity and Competence as I provide full informed consent to Phan about how I intend to proceed, and would solicit his full cooperation.

6. This case epitomizes paternalism. Dr. Suzuki and her family absolutely have the right to refuse the organ transplant, and no doctor has the right to tell them what to do. I would recommend in this case that the Suzuki family be transferred to another nephrologist who demonstrates competence -- cultural competence. As the NASW (n.d.) Code of Ethics defines it, cultural competence "recognizes the strengths that exist in all cultures," and promotes sensitivity and understanding of diversity (1.05).

7. Nancy is clearly in violation of several ethical precepts that basically fall under the rubric of conflicts of interest, which is what a dual relationship entails. The conflict of interest in this situation is between the best interests of the two children, which are the clients in this case, and Nancy's personal interest in becoming a mother. Mrs. Smith's interest are also relevant, although it does not appear that she has yet to sign any formal contract to care for Madison and Jason. This means that Nancy has not yet violated any legal or ethical contract with Mrs. Smith, only that her personal feelings towards the children has led to her actually taking them out with her on a shopping expedition and has told the children that she wants to take them home with her.