Self-Determination

You are working with an inpatient cancer patient who tells you he is interested in ceasing aggressive medical treatment and starting palliative care.  You’ve had experience with patients dying and also with those who choose to end treatment.  However, in your opinion, he is considering hospice earlier than most other patients usually do, when his chance of survivorship is quite high, and it “feels wrong” to you.

Think of similar situations where you feel conflicted, or outright may not agree, with a client’s desires or actions—a pregnant woman who is considering different plans of parenting, adoption, or abortion.  A domestic violence survivor going back to the abusive partner to give him/her another shot.  A graduate student who tells you about some dishonest paper writing or exam cheating.

Social workers encounter plenty of circumstances with clients that raise personal issues for themselves.  In those, it can be hard (but even more important) to stay professional and recall the ethical guidelines.

The NASW Code of Ethics says explicitly (emphasis my own): “Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals.” This is section 1.02, Self-Determination.

Sometimes it seems like a client’s own decision will result in a chance of harm coming to themselves or others, and we know that promoting a client’s wellbeing is another important part of the code of ethics (section 1.01).  

But when can you limit clients’ own decisions?  The following sentence in the self-determination section of the code states: “Social workers may limit clients' right to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.”  Those qualifiers need to be present in order for a social worker to step in.  Thus:

In real life counseling as well as on the ASWB exam (and California Law & Ethics exam), right/best answers in the self-determination category might look like 1) you helping clients explore the pros and cons of various paths, 2) assisting them in making a decision for themselves, and 3) generally respecting their own decisions – excepting issues involving mandated reporting, duty to warn, suicidal ideation with a plan & means to a plan, etc.  

Good luck studying!