ethics

 

 

By Dr Terence Yow, Deputy Director, AMKFSC Community Services Ltd.

 

Disputes among co-tenents, living in rental flats are common problems presented to Social Workers working in Family Service Centres. There are several ethical considerations that Social Workers such as Max, may be facing in the short case-study above.  

 

In addressing ethical dilemmas, Social Workers needs to base their decision making upon Social Work values, principles, theories, concepts and knowledge to guide their practice and decision making. Though “Reamer’s guide to ethical decision making” may provide some suggestions to how Social Worker may address ethical dilemma, some may find it a challenge in applying it towards working with persons with mental illnesses.

 

A common question asked by many Social Workers is whether a person who may be mentally unwell is seen to be capable of self-determination and what can be done if the person refuses treatment. Medication and treatment compliance is often perceived by society to be in the best interest of the person with mental illness. Perhaps, if help can be rendered to ensure Bala’s medication compliance he would be able to function better and his conflict with Raju could be minimized. However, one often may sometime focus too much on the label of mental illness and may negate the personhood of the client.

 

Reamer suggested one Person’s Right to Self-Determination supersedes that same person’s right to well-being.  It is important to recognize that Persons with mental illness have rights to self-determine and to plan for or refuse treatment even when it is societally seen to be not in the person’s best interest (unless the person is seen to be of harm to oneself or others). To impose treatment or to place persons with mental illness in an institution against their will, takes away their rights to self-determination and could further marginalize and disempower them. Hence, in many countries such as United States and even Singapore, treatment cannot be imposed against the will of persons with mental illness, unless they are assessed to be of harm to oneself or others.

 

However, an additional complexity may arise where Bala’s mental health condition and addiction may have caused distress to his flatmate, Raju, who may have felt intimated to give money to Bala, and his sleep being affected in the process. Here, Reamer suggested that one person’s right to well-being (Raju) supersedes another person’s right to self-determination (Bala). Very often, Social Workers often have to struggle with what constitutes well-being and if safeguarding Raju’s well-being may compromise the well-being of Bala in the process. These conditions however do not justify that one can forcefully enforce treatment or place Bala into an institution, against his will, but suggest the need for the Social Worker to look into the issues that Raju is facing, in view of Bala’s possible non-compliance.

 

Social Workers are sometimes triangulated with information provided where the person do not wish to be identified as the information provider. New Social Workers may be influenced by the information provided and may struggle with how they make use of the added information. Upon hearing from Raju that Bala may be using financial assistance received for finance his drinking problem and may be trading off his medication, Max may struggle with what to do with regard to the extension of Bala’s financial assistance and whether to whistle-blow to the psychiatrist on what he heard about the medication. Without evidences, these accounts provided remain subjective and unverified. Being able to verify these information with the client (Bala) requires skills and tact, and the Social Worker may not be able to illicit these information if Raju refused to be associated as the person providing the information. In sharing the difficulty with Raju on difficulties for the worker to verify the information, Max could try to engage and encourage Bala to share with Raju about his concerns on what is happening.

 

Ideally, the Social Worker should seek to understand the situation from both Raju and Bala’s perspective and should attempt to mediate between the two to arrive at an amicable and positive solution for both of them. The Social Worker in providing mediation, facilitates an interaction which allows the two to speak directly to each other on their concerns, listen to each other’s perspective, to seek clarify and to arrive at an outcome which they are prepared to accept.