3 Case Scenarios

CASE SCENARIO 1 HOSPITAL SOCIAL WORKER

Nathan is 40 years old. He is married to Susan and they have two children, Olivia (6 years
old) and Rosie (4 years old). Nathan works as a primary school teacher and is an active
member of his local community through his involvement with one of the local soccer clubs.
Six weeks ago, he was diagnosed with a rare form of aggressive brain cancer. Conventional
treatment for this form of cancer eases some of the anticipated painful side effects, but has
not been successful in significantly slowing down the progression of the cancer. Death is
likely to occur within 12 months regardless of treatment.

The progression of the cancer means that Nathan is unlikely to be able to look after himself
in relation to his basic daily needs within 3 to 4 months. He is currently in hospital receiving
a trial treatment that has had some limited success overseas in slowing the progression of
the cancer, but not in curing it. Nathan has appeared to hospital staff to be calm about his
diagnosis and prognosis. He only becomes visibly emotional when he talks about the impact
on his family. Nathan says that he does not want to “burden his family”. His father died from
cancer when he was younger and was cared for by his mother at home. He does not want
this for Susan and the children.
 
You work as a social worker at the Catholic hospital where Nathan is receiving treatment.
The hospital has an informal policy that discourages staff from having conversations with
patients about assisted dying. You have met with Nathan and Susan together and
individually at different times over the last few weeks. Nathan has asked to speak to you
again. The nurse who made the referral said that Nathan wants to know more about
assisted dying. You know from previous conversations with Susan that she does not
religiously or morally support assisted dying and does not consider this an option for
Nathan.
Introduction ~150 words
A requirement of ethical decision making within social work practice is documenting and
justifying the process of arriving at the decision made, and a framework like Reamer’s can
be useful to ensure all possibilities are covered (McDonald et al 2011 p. 258). This essay
discusses the ethical issues within the case study of Nathan and his family, identifying the
people affected by decisions made. It identifies all courses of action, weighs the evidence
for and against, then discusses my personal values. Then the decision is justified and the
documented.

1. Identify the ethical issues, including the social work values and duties that conflict
ethical, affected, courses of action 11/40 ~530 words
Ethical dilemma: do you provide Nathan with the information he has asked for on VAD,
knowing the hospital and his wife are against it, and he could be asking because he fears
ending up like his dad. (~80 words)

As a social worker it’s my duty and obligation to provide individuals facing dilemma in
society without causing any maltreatment (Chenoweth & McAuliffe, 2014).
Social work duty includes providing information on VAD but social work ethics (5.1.1, 5.2.3,
5.3.1) mean needing to be aware of Nathan’s distress possibly impacting on consent and
giving supports if this is a problem. Social work ethics (4.3, 4.5, 5.1.1, 5.2, 5.2.3, 5.5.1, 7.1.7)
in conflict with hospital informal policy about VAD because the client might not know about
the policy. Personal and professional value of prioritising the service user's self-
determination in conflict with Susan's wish to control Nathan's choices. The ethical dilemma
presented in this scenario is as Nathan’s social worker do I provide Nathan with the
information he has asked for on VAD, knowing the hospital and Nathan’s wife are against
it, furthermore there is also an ethical issue where Nathan could be asking because he
fears ending up like his dad.

Individuals, groups and organisations affected by the decision

Due to Nathan’s progression of the cancer, in a micro level Nathan’s situation may affect his
immediate family, Susan, Olivia, Rosie, by grief, there will also be a marital tension between
Susan and Nathan in regard to Nathan asking information about VAD. As Nathan’s social
worker I may potentially lose my job or my reputation in the workplace. furthermore, the
hospital staff and the management due to their religious beliefs on VAD may have
difficulties accepting Nathan’s choice. Nevertheless, extended family, relative, colleagues,
local community, will be affected emotionally as Nathan will pass in 12 months regardless of
the treatment (Harms, 2010). Therefore, in Macrosystem the Catholic Religion should
provide those who are affected by Nathan’s situation a culturally appropriate grief.
Exosystem - The Dying With Dignity Victoria, who pushed to get VAD into law; Victorian Civil
and Administrative Tribunal (VCAT)
 1. Tentatively identify all viable courses of action and the participants involved in each
action, along with the potential benefits and risks of each
There are numerous possible strategies which might be considered throughout decision
making and getting ethical and equalized understanding. Possible course of action for
Nathan’s case could be working with him and provide Nathan the information he asks for,
another course of action could be to follow the informal policy of the hospital and
discourage the conversation Nathan wishes to have and avoid giving him the information.
Alternivetaly to work with Nathan and give him the information on VAD but also
information on palliative care and the VAD time limit to support his wishes. Another course
of action could be asking Nathan to inform his wife he wants to investigate and get
information on VAD and she will have to respect his wishes, further calling Nathan’s wife
and telling her that her husband is asking for information about VAD.

(~250 words)

Thoroughly examine the reasons in favour of and opposed to each course of action,
considering relevant:- incorporate legal and ethical into decision making 17/40 ~800 words

• ethical theories, principles & guidelines (~200 words)

Reamer, readings from the reading list must go here!

• codes of Ethics and legal principles (~200 words)

Social work ethics: Cultural safety and sensitivity - recognition of own views, bias and
religion, and respect others' views. Commitment to social justice and human rights - show
respect and fairness in interactions with service users promote positive discrimination if
needed. Social work service and propriety - act with integrity, honesty and trustworthiness,
be accountable and obey the law. Social workers will maintain the best interests of service
users as a priority with due regard to the respective interests and rights of others. Promote
policies and practices that uphold human rights. Ensure service users have access to
necessary information for decision-making. Ensure service users understand informed
consent. Report only essential and relevant details, protect service users’ privacy. Respectful
collaborative relationships with colleagues from different ethnic, cultural, religious and
other social locations. Social workers uphold ethical principles and responsibilities of Code
even if employers’ policies incompatible, conflicts must be resolved in line with this code.
Legal principles: Voluntary Assisted Dying Act 2017 (Vic) – Is Nathan within the timeframe;
Medical Treatment Planning and Decisions Act 2016 (Vic) - advanced care directive; Mental
Health Act 2014 (Vic) – Informed consent; Guardianship and Administration Act 2019 (Vic) –
Is his wife going to be his decision maker; Health Services Act 1988 (Vic) – can staff get in
trouble due to an informal policy; Privacy and Data Protection Act 2014 (Vic) – Right to
privacy; Charter of Human Rights and Responsibilities Act 2006 (Vic); Right to life - Every
person has the right to life and has the right not to be arbitrarily deprived of life, Right to
life - this does NOT stop VAD; Recognition and equality before the law - his wife's rights
don't override his rights

• social work practice theory and principles (~200 words)

Readings from the reading list go here!
Conflict between social work and values, ethics

PRO’S AND CON’S

 I could tell his wife,
 What would Nathan think
 What would the AASW think
 What code of ethics would that bridge?
 Privacy law, break ethic
 Might make his wife happy but will make Nathan mad
 The hospital would personally be happy, but officially they might be unhappy.

• personal values (including religious, cultural and ethnic values and political
ideologies), particularly those that conflict with one’s own (~200 words)
Critical reflection goes here!

Consider other courses of action and justify the one you choose 12/40 ~570 words
5. Consult with colleagues and appropriate experts ~200 words
Readings list will have ideas for this.

6. Make the decision and document the decision-making process ~200 words
Discuss why your choice is the right one and what you’d need to do to make sure it IS the
right one (ie linking other supports etc)

Conclusion ~50 words

https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-
care/voluntary-assisted-dying/community-consumer-information/voluntary-assisted-dying-
process/process-to-follow
https://www.betterhealth.vic.gov.au/health/servicesandsupport/palliative-care-in-a-
hospital-or-community-residential-home
https://www.betterhealth.vic.gov.au/health/servicesandsupport/Providing-end-of-life-and-
palliative-care-for-someone-at-home
https://www.aasw.asn.au/document/item/1201
http://www5.austlii.edu.au/au/legis/vic/num_act/vada201761o2017348/
http://classic.austlii.edu.au//au/legis/vic/consol_act/mha2014128/
http://classic.austlii.edu.au//au/legis/vic/consol_act/gaaa2019304/
http://classic.austlii.edu.au/au/legis/vic/consol_act/mtpada2016351/
http://classic.austlii.edu.au//au/legis/vic/consol_act/hsa1988161/
http://classic.austlii.edu.au//au/legis/vic/consol_act/padpa2014271/
https://www2.health.vic.gov.au/Api/downloadmedia/%7BF89F948E-5FBB-4100-BC9E-
D2CE58614410%7D
https://www.dwdv.org.au/
http://www5.austlii.edu.au/au/legis/vic/consol_act/cohrara2006433/
https://www.oup.com.au/__data/assets/pdf_file/0024/167109/HARMS_9780190323493_S
C.pdf