7.4 Handling Ethical Dilemmas
In human services, we will always run into problems where issues are subject to interpretation. Some will be interpersonal conflicts, and others will be ethical dilemmas. For both situations, we need to know how to proceed to solve them. When faced with an ethical dilemma, we can approach it by focusing on the consequences of our actions, or we can focus on the actions themselves. Because we are bound to our code of ethics and standards, we have to ensure that our actions do not cause harm or foul play and that we do not engage in acts that are wrong by their nature—e.g., blackmail, coercion, etc.
Case Study: An Ethical Dilemma in the Field
I started my 440-hour internship journey at an adult living facility. This was an all-around care facility, and its residents ranged from people who were completely independent to those who needed extra support in a memory care setting. I mainly supported people within the assisted living part of the facility. Some of the individuals experienced physical disabilities, others experienced differing levels of dementia, and some experienced both. Everyone was different and unique with their own personal care needs. I gained a couple of amazing skills while interning there. One of those was how to redirect. Towards the end of my internship, I had gotten the hang of how to use this skill but had one very unexpected challenge arise involving sexual consent among older adults. Now, this situation tends to become a hot-button issue because it revolves around sexuality. This is not really talked about in facilities, which leads to the stories of rampant sexually transmitted diseases (STDs) within nursing homes. Families may not want to have these types of conversations and, in some situations, forbid their parents from engaging in these activities.
I got to experience this situation unfold firsthand. A new woman entered the program and was immediately smitten with one of the residents. The woman was said to have been highly functioning with the dementia she experienced, whereas the male was stated to have a lower amount of cognitive function. He would recite nursery rhymes and make funny noises. He could answer questions in the moment but did not remember a lot. The two began a physical relationship. Not long after, the family of the man found out that they were together and decided that was not okay. They told the facility to keep her away from him and that it was wrong for them to be together. This was my first experience in learning about the intricacies of working with people.
The family was the legal guardian and had the power to make decisions on his behalf because he was deemed unable to make decisions in his own best interests; it also could have been that he did not have the mental capacity to consent to a physical relationship. The family saw the woman was very aggressive in her pursuit of this relationship, and they saw her behavior as predatory. The man said yes to her, but the concern was whether or not he was able to consent and if he understood what was going on. So, the family then told them they were not allowed to continue the relationship, and now the facility, myself included, had to enforce it.
Since I was new and unknowledgeable about how to handle the situation, I did what I was instructed to do and kept them away from each other. This was easier said than done on a bus with limited seating and two people determined to see each other. My supervisor told them they could not sit together and did not allow any type of wiggle room. So here we were, with me sitting next to a confused, upset man, and the women behind us yelling and complaining about the treatment that they were receiving. This only made the man even more upset.
Using the tool of redirection, I asked the man, “Hey, how was your lunch? I only had the biscuits and soup. What did you get?” He said, “I do not remember what I had.” The lady behind us said, “Oh, you had the seafood alfredo.” He said “What? I did? Are you sure? I don’t have any leftovers.” She replied, “Well, because you ate it.” He looked at me and said, “Welp, guess it was good then.” This kicked off laughter about the food, and everyone jumped in on the conversation. I will always remember the sigh of relief that came from my supervisor. This encounter and how I handled the situation was the best use of the skills I learned working with these individuals. The gift of distraction became another tool in my tool belt.
Identifying Issues Early
The best time to solve ethical dilemmas is before they become major issues. It may be that you are feeling inclined to overshare with a client. You may have heard colleagues talking about clients in a local restaurant in a manner you thought could identify people. It may be that you have an “out of the box” idea for assisting a client, but you’re not sure if it is within agency policy. Sometimes you may feel like you are overreacting or being an alarmist. If you are feeling unsure about a situation, trust your instincts. Especially as an intern, you are still developing your own professional identity and direction. It may turn out to be a non-issue, but responding ahead of time is much easier than figuring out a solution when a dilemma has already developed.
Asking for Help
When you have questions about possible ethical issues, the number-one most important step is asking for help and guidance from a trusted colleague or supervisor. Asking for help is not a sign of weakness but of determination to overcome a hurdle. I frequently tell students the best way to find themselves in the middle of an ethical problem is to keep the issue to themselves. When you are unsure of a situation, your supervisor and colleagues are the best sources of information and guidance. They will be more familiar with the agency policies and have possibly been involved in a similar situation.
When you say you could use some input handling a case, it may make you feel vulnerable and as if you are unable to handle the work. The truth is that all of us have been in a sticky ethical situation at one time or another, and asking for assistance can be a sign of growth and humility. Asking for input greatly expands the body of knowledge and expertise available to you with which to view the situation and decide upon a course of action.
Your Instructor and Classmates as Resources
By the time you are completing your internship, you may have spent months or even years with your teachers and classmates. You and your classmates are now completing the final step in your education before either going out to begin your career or moving to the next step in your education. Do not overlook them as a source of support when you are having ethical questions. In fact, it is extremely unlikely that you are the only student in your cohort who is going through or has gone through an ethical dilemma themselves. Your instructors also bring a wealth of professional experience and knowledge that they are happy to share. Your willingness to discuss your issues will again give you access to more points of view and may also encourage other classmates to share their own concerns. This enriches the educational experience for all of you.
Handling Ethical Dilemmas Licenses and Attributions
“Handling Ethical Dilemmas” by Yvonne M. Smith LCSW is licensed under CC BY 4.0.
“An Ethical Dilemma in the Field” by Harry Norris BSW is licensed under CC BY 4.0.
situations in which you are faced with unclear choices about how to handle a situation with a client. This may be a difference between your ethical guidelines and another’s, a conflict between your personal and professional ethics, or a clash between two competing ethical standards.
Ethics are a code of morals or a philosophy that guides an individual’s behaviors and actions. Ethics also include a set of standards or code of conduct set forth by a company or profession.
A credit class in which students apply theory to practice by using what you have learned in coursework in a real-world setting with a supervisor/mentor who is invested in your growth and development (often also referred to as fieldwork or practicum).