Marie Antonette D.

De Guzman
SW 201 Generalist Social Work Practice
Self-Reflection Essay
September 1, 2017

Self-Reflection Essay

Uphold the sanctity of human life at all times, a universal principle that every human
being irrespectively of race, sex, age, status and culture has to abide. In social work
profession the principle that man has worth and dignity is always the basis for intervention.
These two concepts were always put above all in every practice and in my experience as a
social worker in the field of health setting I witnessed different scientific and philosophical
way of every professional to preserve this human life and also how it naturally ends.
As young as 21 years old, newly graduated and licensed professional I decided to
enter the field of health setting with thinking that I could help every individual and family in
dealing with their present health problem. I was assigned to handle cases of patient diagnosed
with Chronic Kidney Disease (CKD) who was also advised to undergo renal replacement
therapy through Dialysis. One of my cases at that time was a challenging and medically
speaking a toxic one in terms of how poor the prognosis of the patient and how she was
diagnosed of minimal chances of survival.
Patient is a fulltime homemaker of the family while her husband is engaged in
different odd jobs available in the community. They have six children who majority were out-
of-school youth. In assessing the dynamics and source of income of the family, I know from
my first encounter with them that they could not be able to sustain the cost of hospitalization
much more the needed sustenance of the treatment considering that it is for lifetime. Patient
was hooked at a mechanical ventilator because her pulmonary functioned failed and the latter
could not breathe on her own thus need a life support. One of my roles in my agency is to
keep close coordination with multi-disciplinary team to monitor the development of patient
and to know further treatment plan and subsequently discuss it with the family.

The attending physician explains that the patient has 20% chance of survival and the
only reason that she is still able to breathe is because of the life support then once she is
remove from it immediately all of her organs will stop functioning. Patient’s hospital bill
abruptly increasing considering all the procedure, medicines and machineries provided to her,
family failed to provide any counterpart from it, although they are under the services of our
division it is not enough to suffice the expenses amounting to P 200, 000.00 at that time.
Patient has no health insurances even PhilHealth as well.

Breaking the bad news with the family has never been an easy thing and puts me in a
difficult situation. In this specific case there are two things that I need to consider, one that I
am a social worker and two as a public health worker. Both have the same principle of human
life and to serve people. As a newbie in this setting I tend to be idealistic in terms of
integration of theories I’ve learned in college days and practice, working in a government
hospital, funds are the primary aspect that has to be considered in terms of provision of
services and this specific case alarms me considering the continuous increase of expenses
with no assurance of surviving.

Immediately I conducted a family session and informed them with the hospital
expenses and current status of the patient. Family is still aggressive with the treatment
regardless if they don’t have money to support. They have this outlook that “life is more
important” and they leave all the financial concern to our division because for them it is our
responsibility to help them given their indigent status. That’s when the dilemma started.

I’m torn between considering the principle of my profession of self-determination

from which it is the right of client or the family to make their own choices as long as it does
not have a harmful effect to them and my duty as public health worker to provide services in
a cost-effective manner. At that time the latter speaks more and my only goal is to direct the
family into accepting that patient’s condition is critical and deteriorating that cost too much
resources to the hospital but does not guarantee a good result. I felt like I’m a heartless person
and that leave a supreme guilt feeling that I started to question myself “is this the right thing
to do?”

I consulted a senior social worker, the latter explain to me that part of my duty is to
consider the agency’s resources in providing an intervention and to accept the reality we all
do have a limitation. She proposed that the patient must be referred to a palliative care team
for a different approach of treatment.

Before I pronounced with the family the plan for palliative care, I asked for the help
of multi-disciplinary team in order to explain the further intervention from different
perspectives. A family conference were conducted and the end the forms such as
“do not resuscitate” (DNR) and “do not intubate” (DNI) were discussed. At first, they are still
contemplating with the proposed plan of providing supportive care for the patient, some of
them think that it is an idea of killing and they don’t want to take part from it, for them they
leave the fate of patient to God and let the patient die on her own and natural way.

Series of ward visit were conducted with coordination of inter-disciplinary team and
eventually family decided to gradually remove the apparatus that attached to the patient and
to provide medications instead. They still ask the patient to intubate but they signed the DNR
form.

For me with this case the question of what is right or wrong depends usually with the
situation. In a hospital setting it is normal to see the impermanence of life that not every
patient’s journey is a usually lead to being cured particularly with chronic cases. You can still
observe the dynamics of Filipino families and the dominant values and beliefs plays a bigger
role in terms decision making. And my learning with this experience is that some of the
principles that have been taught are not usually viable in applying in real life situation, as a
social worker we need to learn to adopt with the complex aspect of human life.