SOCW 6121 Week 10 NASW Ethical Dilemma Analysis Example

He Asked for a Method the Worker Was Not Trained to Use: An NASW Ethical Dilemma Analysis Weighing Competence, Self-Determination and Informed Consent Through Reamer's Decision Sequence, Four Options Set Side by Side and a Coordinated Referral Chosen

Student Name

Walden University

SOCW 6121: Advanced Clinical Practice II

Instructor Name

Month Day, Year

He Asked for a Method the Worker Was Not Trained to Use: An NASW Ethical Dilemma Analysis Weighing Competence, Self-Determination and Informed Consent Through Reamer's Decision Sequence, Four Options Set Side by Side and a Coordinated Referral Chosen

The Dilemma

Dale, the client whose composite case this course follows, asked his social worker to use eye movement desensitization and reprocessing with him for his memories of the workplace accident, because a former coworker told him it had helped. The worker is not trained in that method or in any trauma-specific treatment, and Dale said he did not want to "start over with someone new" after building trust over nine sessions.

The Duties in Conflict

Three standards of the NASW Code of Ethics bear on the case (National Association of Social Workers, 2021). The standard on competence directs social workers to practice only within what their education, training, license and supervised experience prepare them for, and to use new interventions only after appropriate study, training and supervision. Competence is also one of the Code's six core values. The self-determination standard asks social workers to honor and advance a client's right to choose, and to help clients work out what they want. The standard on informed consent requires that clients understand the services offered, their risks and the reasonable alternatives.

The conflict is real. Respecting Dale's choice of method and of worker points one way; the worker's limits of competence point another. Informed consent sits between them, since any option requires that Dale understand what the worker can and cannot offer.

Decision Sequence

Reamer (2018) sets out a sequence for ethical decision making: identify the ethical issues, including the values and duties in conflict; identify the individuals and organizations likely to be affected; identify all viable courses of action, with their benefits and risks; examine the reasons for and against each in light of the Code, ethical theory, law and agency policy; consult colleagues and experts; make the decision and document it; and monitor and evaluate the decision. The analysis below follows that sequence.

Affected parties. Dale is affected most directly. His wife and son, who have seen improvement in recent weeks, have a stake in the progress continuing. The agency is affected, since it offers outpatient counseling, not trauma-specific treatment, and carries responsibility for the quality of its services. The worker is affected professionally.

Four Options

Option 1: attempt the method after self-study. The worker could read about the method and attempt it. Benefits: Dale's preference is honored and the relationship is preserved. Risks: the method involves structured processing of traumatic memories, and attempting it without training could increase distress and do harm. This option strains the competence standard directly and would compromise informed consent, since Dale could not be told honestly that the worker was qualified.

Option 2: decline without discussing alternatives. The worker could simply say no. Benefits: competence is protected. Risks: Dale's request is dismissed, his trust may be damaged and his trauma symptoms remain unaddressed. This option honors competence while straining self-determination and informed consent, since Dale is not told what alternatives exist.

Option 3: transfer the case entirely. The worker could close the case and refer Dale to a trauma clinician for all services. Benefits: Dale would receive trauma-specific care from someone trained to provide it. Risks: the gains on structure, the job search and family routines might be lost in the transition, and Dale has said he does not want to start over. This option honors competence but treats his preference about his worker as unimportant.

Option 4: coordinated referral while current goals continue. The worker could refer Dale to a trained trauma clinician for trauma-specific treatment, with his consent, while continuing the current work on his three treatment goals, and coordinate with the trauma clinician. Benefits: Dale receives competent trauma care, keeps the relationship and the progress already made, and makes an informed choice. Risks: two providers require coordination, and Dale may find it burdensome to attend both. This option honors competence, respects self-determination in his choice of whether to accept the referral, and depends on full informed consent.

Consultation

The worker brought the case to her clinical supervisor before the next session. The supervisor agreed that the method was outside the worker's competence, confirmed that the agency had a referral relationship with a trauma clinic that could see Dale within three weeks, and advised that concurrent services were acceptable with a release of information and regular contact between providers. Dolgoff et al. (2012) emphasize that consultation is part of ethical decision making, not a substitute for it; the decision remained the worker's and, ultimately, Dale's.

The Decision and the Informed Consent Conversation

Option 4 was chosen. In the following session, the worker explained to Dale that she was not trained in the method he asked about and that attempting it without training could do harm. She described the trauma clinic, what the method would involve and what other trauma-specific options the clinic offered. She told him the current work on morning structure, the certificate and family dinners could continue with her. She also told him that he could decline the referral and keep working with her on his current goals alone. Dale asked whether he could think about it for a week, and the worker agreed and documented the conversation. At the next session he accepted the referral and signed a release allowing the two providers to coordinate.

References

Dolgoff, R., Harrington, D., & Loewenberg, F. M. (2012). Ethical decisions for social work practice (9th ed.). Brooks/Cole.

National Association of Social Workers. (2021). Code of ethics of the National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

Reamer, F. G. (2018). Social work values and ethics (5th ed.). Columbia University Press.