HHS 220 INTRODUCTION TO HUMAN SERVICES 3

DQ 3

Because human services work often involves direct client interaction, there are times when the values of the worker differ from those of their clients. In these circumstances, ethical dilemmas tend to arise. Review the case examples and current ethical conflicts presented in Chapter 5 of your textbook. Choose (1) case study and (1) ethical conflict to discuss, and present the dilemmas involved in each case. As a human services professional, how would you handle these situations? How would you balance your values as a professional with a client’s needs?

CASE EXAMPLE Falsely Accused, a Mother Fights Back

SCITUATE, MA—The call that brought terror into Brenda Frank’s life came on September 17, 1986. A social worker with the Department of Social Services informed Frank that an anonymous complaint of sexual abuse and neglect of her two young daughters had been filed against her.

“I was frozen. Shocked. It was beyond my comprehension,” said Frank, during a recent interview in the living room of her modest two-bedroom apartment in this seaside town. “The allegations included the fact that my 4-year-old, Emily, was still being breast-fed occasionally and that both girls (Emily and Rebecca, or Becky, then 6) slept in my bed with me.”

Where did such allegations come from? Did she have an unknown enemy out there somewhere?

“I felt so vulnerable,” said Frank. “Everything you do is put under a microscope by DSS and you have to defend your every move. I stopped letting the girls sleep with me. I wouldn’t let them go outdoors to play in case they fell and got hurt. It was all so very isolating. But I didn’t know who to trust. I didn’t want anyone to see me, the lady accused of abusing her kids, riding my bike around town or walking down the street.”

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When Frank received the phone call from DSS, she had been separated from her husband for five years and was a stay-at-home mother living on welfare. Although finances were always an issue, Frank said she was grateful to have two healthy children, a roof over her head in a town with good schools, nearby stores that she could reach by bicycle, new friends, and like-minded young mothers she met through La Leche League (a group advocating breastfeeding until a child naturally weans herself).

Frank describes what happened when the worker from DSS came to her home:

“I was very nervous and frightened and had my mother, a nurse, come for support,” said Frank, who had read dozens of books on nutrition, childbirth, and parenting during her two pregnancies. “But I felt sure that all I had to do was explain the La Leche philosophy of child-led weaning and give her some of their literature. I thought I would show her their literature and the stuff I’ve been reading about the concept of mother and child sharing a bed. I had a book by Tine Thevenin called The Family Bed: An Age-Old Concept in Child Rearing.

“I told the worker that I didn’t agree with the fact that in our country children are expected to sleep alone at night in their own rooms behind closed doors. I told her my girls slept with me because I wanted them to feel safe at night.”

Several days later she got a letter from DSS telling her that the allegations against her had been substantiated. It said:

“You have neglected to guide your children in age-appropriate individuation development and have exposed your children to sexual stimulation with your belief in the concept of the ‘family bed.’ ”

“In other words,” said Frank, “I was found guilty of the way I had chosen to parent.”

Frank believes the person who anonymously reported her to DSS worked at her complex and might have been angered by Frank’s advocacy against the use of pesticides on the grounds and for the ability of elderly residents to have pets.

Frank turned to a lawyer for help. They appealed to the commissioner of DSS for a review of her case. It was under this review that the allegations against her were dropped. But it would be 1989—two years later—before her name was finally taken off DSS’s central list as an alleged perpetrator.

Frank may have won her own battle, but she has not remained silent. She continues to testify before state legislatures, to pore over books in law libraries, and to counsel others. (Doten, 1991 )

Ethical conflict

Some conflicts between the individual and the community spring from conflicting interpretations of morality. For example, does an individual have a right to choose to die, or does the state have the right to forbid that choice? If a terminally ill person wants to die, should a doctor help her or him do so? Do parents have the right to decide on euthanasia (also called mercy killing) for their terminally ill child?

CASE EXAMPLE Andrea

Andrea was a 9-year-old girl who had been diagnosed as having cystic fibrosis at the age of 13 months. Since then she had been hospitalized twelve times, eight times during the last year.

When admitted for the last time, she was already receiving an experimental antibiotic, which was being administered in an attempt to control a resistant pneumonia superimposed on severely damaged lungs, a result of her underlying disease. She was at that time a severely ill, emaciated child with moderately labored breathing. She seemed to have no interest in her environment and refused to communicate with anyone but her mother.

The parents indicated that in the event of a cardiac or respiratory arrest, they did not want their child to be resuscitated, and the appropriate medical order was written. The child was not involved in these conversations or subsequent decision making.

As this child’s condition continued to decline, the parents asked the doctor how much longer she would live and how she would die. At one point the father said: “Watching your own child die is worse than dying yourself.” This comment led to a discussion of active euthanasia utilizing intravenous potassium chloride or a similar drug. The physicians pointed out that no matter how hopeless a situation or how much suffering the patient and family were enduring, the law prohibits the active taking of a patient’s life. They refused to consider this option. The following day, Andrea’s heart began to fail. Her condition became progressively worse, and she died approximately forty-eight hours later. During these last two days, her parents were in great despair because of her steadily deteriorating condition. They felt helpless and impotent to alleviate their daughter’s distress. Medical treatment was continued to the end, and no measures were taken to hasten Andrea’s death.

Approximately two months after her death, the mother was asked if she would still have given permission for active euthanasia if she had been offered that option. She replied, “Yes.”