Social work principles and practice

Ocial Work Practice With Individuals: Engagement Strategies

First I need to get past Mr. Fahza's son in order to get to his father. I need the former's agreement because I need a smooth start. His son agreement would encourage a discussion under the right auspices.

According to The Patient Self-Determination Act (PSDA) of 1990, Mr. Fahza has the right to be informed about his own clinical condition in order to take a decision about continuing with chemotherapy or going to the hospice and die peacefully. This is the strict approach of the western hemisphere.

The religion of Islam believes in death and resurrection of the body and soul, like Christianity. Islam also teaches about how to prepare for death, when aware that death is imminent. Statistics show that a vast majority of the American male population would want to know about the eventuality of dying because of a fatal illness in its final stage. As a male Shi'a Muslim, in his late eighties, Mr. Fahza is very likely to feel relieved and even grateful for having been told he could go home and prepare for his end because there is nothing medicine can do for changing this end.

Chemotherapy is a long, strenuous and very painful treatment, an 87-year-old, in his last stage of cancer, is more likely to be willing to give it up, once he was told his cancer was in his final stage.

One must keep in mind that informing a patient about his condition is completely different than euthanasia, for example. The preliminary discussion with the son should set the record straight in this regard. The social worker will not bring the word into discussion, but she will help the son gradually come to this conclusion on his own terms.

As literature indicates, it is very important that the social workers is aware of the meaning of death for a Shi'a Muslim, originally from Iran, about the attitudes toward death in his community. The patient's origins and his American experience are also important. Furthermore, the patient's son is by his father's bedside, which means there is an additional emotional charge to the whole situation that I need to handle carefully.

Social workers are required to approach their patients with a first thought in mind: patients are individuals. Statistics can help only up to a point. The information firsthand is more important than statistics in that it helps the social worker form an accurate image of a certain individual in a special circumstance. As individuals, patients have a background. It would be of great help for the social worker to know beforehand (maybe she could find the information from the son) or find it out from Mr. Fahza himself, for how long has the patient been living in the U.S. She knows the patient does not speak English, so she is aware that acculturation could have produced only to a very limited level. The social worker also needs to find out about the patient's level of education, his occupation, about his living style and the rest of his family.

After having gathered all the necessary information in order to tackle a matter of life and death, the social worker must pay attention not to stereotype and fall into miscommunication. Questions related to assistance from the part of the care provider in view of his imminent death are important in order to further build the patient's trust that the social worker is on the right track.

Answers to questions about decision-making style in Mr. Fahza's family are also relevant in this case. Information about how his family functions and other important persons in his life would also help the case.

In order to find out a good deal of this information, the social worker needs to have inspired trust and acceptance of her work. The patient needs to trust her first as a person, then have trust in her competence as a social worker. At first sight, there could be only minor commonalities between her patient and herself. Inviting him to talk about anything and encouraging him to stop or change the subject when he no longer feels like discussion a subject will help the social worker in establishing a good rapport with the Mr. Fahza. Mr. Fahza is just about to find out that he is going to die soon, but he will also know that he will be in control of his last days. (Kagawa-Singer, M., & Backhall, L. (2001))

Barbara A. Koening and Jan Gates-Williams also warn against the dangers of stereotyping. One the social worker got enough information about the personal life of a patient, she will carefully analyze and refrain from making assumptions based on what the majority of similar situations might suggest. Comparing is only good when in tandem with contrasting in a social worker's line of work. The authors emphasize that studies, research results, statistics are useful tools for a social worker as long as he or she keeps in mind that the persons she is talking to are individual human beings dealing with facing extreme situations. Anyhow, the views of the two may essentially differ in what concerns placing Mr. Fahza in hospice, at home. The son may have various reasons for not willing to have his father die at home. It is important to try to find out why the son insists on his father staying in the hospital. Apart from the possibility of denying his father is actually dying, there could be other reasons that lead him to insist on his father staying in the hospital, even if it means being treated with chemotherapy for cancer. The social worker needs to be aware of the differences of opinions between the two, if there are any and try to find the best possible solution for the patient.

In the case of Mr. Fahza, I would try to empathize with him by showing not only that I pay attention and make serious and sustained efforts to understand his position, but that I am also aware of how important discussing about his own end of life is for him. From a religious point-of-view Muslims are encouraged to prepare for the after life continuously. The moment of death becomes of crucial importance to them. In the case that Mr. Fahza has turned his face away from religion at the last moment, this could be easily spotted even to an untrained eye. Depending on his attitude towards death, I will make my decision on how to tackle the next step: his consent for being put on hospice at home. From my point-of-view, this would be the most dignifying, less painful way to die for any human being. But, since it is not me who is dying, I will take into consideration his mental state and his willingness to confront death at home instead of intubated on a hospital bed.

My strategy would be to find out first what role does the Muslim religion play both in Mr. Fahza's and his son's life. It is also important to find out about their family's dynamics, in order to know who the decision maker is in their family. After having built a trustful relationship with the patient and have let him start talking about his situation, I would assure him that what he feels is absolutely normal. Body language and facial expressions are important, too.