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The responses below are personal opinions and perspectives.

Karen Kok
Senior Care Standards Officer
Destitute Services Branch
Ministry of Social and Family Development
Hannah Chow
Senior Social Worker
The Haven (Salvation Army)

I feel that some ethical guidelines useful for social workers handling “unusual” cases might include:

  • Having platforms to raise complicated/difficult cases for discussion and consultation, preferably with multi-disciplinary teams so that more holistic assessments/recommendations can be made

  • Knowing the limits of one’s knowledge/competency so that cases we are uncomfortable with/unsure of handling can be referred for relevant assistance

  • Being aware of one’s feelings/attitude towards our clients so that we would not be enmeshed and feel like we have to help the person no matter what instead of seeking a second opinion

  • Understand that we would not be “betraying” our clients’ trust if we refer them for specialised intervention, where required

  • Last but not least, practice lifelong learning and improvement, especially in areas one has particular interest in…

 

Before making decisions on whether to conduct clinical sessions with Qiu Min, Jane could have considered several ethical guidelines.

Jane needed to recognise that professional responsibility takes precedence over personal aims and views.  Social workers provide services and represent themselves competent only within the boundaries of their education, training, licence certification, consultation received, supervised experience or other relevant professional experience. In this case, she does not have formal postgraduate training on treating eating disorders. She based her limitations in knowledge of what she had learnt in literature/ university presentations/ clinical courses, to conclude that she had sufficient ability to intervene in Qiu Min’s medical condition.

With what Jane had learnt regarding eating disorders, she could have reflected on whether she was the best person to provide consultation/ counselling for Qiu Min. Suppose that she was aware that she was not the best person and yet went ahead with counselling Qiu Min, she would have disregarded the ethics of affirming the right to client self-determination by ensuring that client is both aware of and has assessed alternative options.  Jane was to provide all relevant information about going to an eating disorders clinic for advice, so that Qiu Min could make an informed decision.

Suppose that Jane was unsure of whether she was the best person to work with Qiu Min, she could consult her own clinical supervisor about this case. This would be in line with the ethical guideline of social workers acting on the recognition that effective service depends on cooperation among professional disciplines and others with due regard to respective areas of competence. This was in regards to her supervisor having more years of seniority/ experience as well as the professionals who work with eating disorder clients.

Qiu Min suffered from depression as indicated in the abstract. I am unsure if it referred to clinical depression, but the fact that she also had binging on food and purging signs alongside with depression might indicate that Qiu Min was having a more serious medical condition than perceived by Jane. I am surprised that Jane did not seem to have approached her supervisor for advice, as it was not mentioned in the abstract.

Even as Qiu Min continued to struggle with the eating disorder and Jane did not see any improvement especially over a long period of 3 months, Jane’s inefficiency at practice (which would also be due to her lack of ethical guidelines and not perceiving this situation as a crisis) had resulted in harm to client in an increasing manner. According to the passage, it was even more difficult to treat Qiu Min’s medical condition which had worsened and could have been prevented.

Jane’s incompetency in practice had serious repercussions on Qiu Min’s health and psychological/ emotional conditions. Qiu Min’s family was also deeply distressed and they might even lose their daughter eventually. Ultimately, Jane had to face the consequences of making her own decisions without much consideration to conducting professional practice. In this case, she was alleged by Qiu Min’s family of incompetent practice through the Accreditation Board.  Jane had risked losing her job, career path and reputation as a Social Worker. If this case was brought up to the media, Jane would face much shame and a bad name for the organisation she was working for. 

In my opinion, Jane should abide by the social work ethic of responsibility as professionals and be cautious of the services provided to Qiu Min as she is considered a minor. Jane was trying her best to help Qiu Min however, she did not realise her limitations as a social worker. Since she had done an advanced clinical courses on treatment of eating disorders in her university, she should have known that treatment of eating disorder should be managed and treated by psychiatrist that is out of her competency level to provide the service to her client. However, she could continue to provide emotional counseling to Qiu Min while she is seeking treatment at the hospital as a form of support system which is within her boundary of work.In addition, it would be helpful for Jane to consult her supervisor or seniors on managing of her clients when she received further request, information or progress of her clients during the sessions so that she could meet client or the family's expectations.

Ng Chai Hwee
Medicial Social Worker
Renci Hospital

Read the ethical considerations HERE

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