By Elaine P. Congress, DSW, Chair of Committee on Ethics and Professional Standards, and
Linda Stern, CSW
(October 1994)
| Mrs. Smith, an 81 year old widow, lives alone in an apartment where she has been for the last fifty years. Her husband died over twenty years ago and her son and his family live in another section of the city. Often her neighbors would help out, but in the last few years most of her neighbors have either died or moved away. |
| Despite arthritis, diabetes, and some visual impairment, Mrs. Smith has been able to function independently with minimal supports from family or friends. Three recent incidents, however, have made her son question if his mother can continue to live independently. About two months ago while she was cooking, the kitchen curtains caught fire. The fire department was summoned, and was able to put out the fires before there was extensive damage to her apartment or the building. No one was injured in this fire. This was the second fire Mrs. Smith had inadvertently set. The first started when she turned on the stove without removing a dish towel that was next to a burner, but she was able to extinguish the fire by herself. About five weeks ago, Mrs. Smith fell in the bathtub. Fortunately, she did not sustain any serious injury, but her bruises make it even more difficult for her to shop and carry groceries up to her third floor apartment. Her son would like her to move into a congregate living setting for older adults in his community. Mrs. Smith is adamantly opposed to this idea and wishes to continue living independently in the community. As a social worker, how would you intervene with this family? |
In exploring an ethical dilemma, it is best to first consult the NASW Code of Ethics to ascertain if any parts of the Code help in resolving this dilemma. A study of the Code indicates that the "social worker's primary responsibility is to clients," (II, F). Is the client Mrs. Smith, who is the more vulnerable and for whom the possibility of service is raised? Mrs. Smith may not have solicited services, while her son may have sought assistance. If one considers both Mrs. Smith and her son as clients, there is a conflict of interest and a question arises as to whom the social worker has primary responsibility.
The Code of Ethics also stresses that "the social worker should not practice any form of discrimination on the basis of...age...," (II, F, 3). Are there any indications that because of her age, Mrs. Smith may be the victim of discrimination? Older people are often the victims of ageist beliefs and practices, especially in the American culture, which is youth oriented. One characteristic of ageist discrimination is that often behavior of older people is seen as indicative of growing physical and mental infirmity. This in turn is used to question their competency to make independent decisions.
The curtain fire incident is serious in that not only is Mrs. Smith's safety an issue, but so is the safety of others in her building. Social workers have a responsibility to society as well as to their individual clients. Yet, we wonder if Mrs. Smith were 51 instead of 81, would this curtain fire incident have been used to suggest that she could not continue to live independently in the community.
A third Code of Ethics provision which may apply is that the "social worker should make every effort to foster maximum self-determination on the part of clients" (II, G). This suggests that the social worker should promote the right of Mrs. Smith to self determine where she should live. Even though self determination is a basic principle in social work practice, all practitioners know that there are situations in which the client should not be given the right to self determine. Common exceptions to clients' right to self determine include suicide intent, homicidal intent, or child abuse. One can ask if allowing Mrs. Smith to self determine about living independently places either herself or others at risk. It is crucial before questions of competency are raised for the social worker to meet with Mrs. Smith to assess her perception of the situation.
How should a social worker proceed with this case? A study of the Code of Ethics does not point to specific solutions. To further help in considering this issue, the social worker might want to:
Social workers have an ongoing professional responsibility to increase their knowledge and skills in working with diverse vulnerable populations. In the New York City social work community there are frequent opportunities for social workers to learn more about working with older persons. On December 8, a half day conference will focus on ethics committees and ethical decision making in long term care. For more information, contact Dr. Paulette Sansone at (718) 548-1700, ext. 224. In March of 1995, Betty Friedan, the author of the recent book The Fountain of Aging, will be the introductory keynote speaker for an Invitational Colloquium on Aging at Fordham University. Although admission to this lecture is free, social workers interested in attending should contact Dr. Irene Gutheil at (212) 636-6655 to make a reservation.