Informed Consent and Confidentiality Term Paper

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Competence refers to the practitioner's accurate self-representation of credentials as well as contributing to the profession by undergoing ongoing professional development throughout the career. Although competence is a distinct value from integrity, it is also related to integrity because all social workers should have the personal and professional integrity to practice only within their realm of professional training and competence, and also to upgrade their skills according to emerging research, theory, and policy. The NASW (n.d.) also points out in its Code of Ethics that competence is integral to the protection of clients from harm (p. 2). Informed consent, although a distinct ethical practice, is linked to professional competence in several ways. According to the NASW (n.d.), "social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent," (1.03). Informed consent promotes respect for clients as well as client autonomy, and informed consent also protects clients from harm. Both informed consent and competence are covered under the rubric of social workers' ethical responsibilities to clients.

Informed consent and competence are both ethical responsibilities to clients because both provide clients with the knowledge and power they need to make educated decisions. Competence ensures that the client is receiving information from the best possible source, and informed consent ensures that the client has received all information accurately and is not being deceived in any way. When a social worker is working with "an emerging area of practice," for which "no generally recognized standards exist," the professional and ethical obligation to the client remains full disclosure as well as acquiring either research or supervision to protect the client from harm (NASW, n.d., 1.04). Both informed consent and competence protect clients by ensuring clients have access to any and all information relevant to their case and their needs, ensuring also that the social worker will have the ethical judgment to refer the client to additional services or information when necessary.

2. The Dutch euthanasia law is progressive and responsible. Although it is a controversial issue, I do believe that assisted suicides in cases like that of Mark Langedijk are morally and ethically permissible from several principles. For one, the Dutch system ensures that a physician presides over each case and did so in Langedijk's case. "His death was approved by a doctor from Support and Consultation on Euthanasia in the Netherlands, a medical body that oversees requests from those who wish to die with the help of the state," (Richardson, 2016, p. 1). The assurance of competence from an established medical board and competent physicians ensures that the process of euthanasia occurs with rigorous clinical oversight and good professional -- as well as ethical -- judgment. Informed consent is built into the system, as the patient must initiate the euthanasia request in cases like that of Langedijk.

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The most important elements of the Langedijk case that highlights the ethical tenets of a liberal euthanasia policy is patient autonomy, self-determination, and freedom. A patient does have the right to "die with dignity," in a manner according to his or her will, especially when a presiding physician has determined that the case clearly warrants compassionate intervention. Moreover, the liberal approach to euthanasia exemplified by the Dutch does reduce medical paternalism, which interferes with patient autonomy. I do not believe that the Langedijk case is appreciably different from that of Sandy Bem. Both underwent extensive suffering in their lives and both made their decision in the absence of any coercion. As Henig notes, it was "plain that her death was her decision alone," (p. 18). Langedijk was "in and out of rehab 21 times to try to treat his battle with alcohol," and yet opponents of the Dutch law have ironically claimed, "What someone suffering from alcoholism needs is support and treatment to get better from their addiction -- which can be provided -- not to be euthanised," (Richardson, 2016). The former comment epitomizes medical paternalism.

3. Confidentiality is covered extensively in the NASW Code of Ethics, as it applies to different types of situations and relationships, in Section 1.07. There are a few instances in which a social worker may breach confidentiality. The NASW uses the phrase "except for compelling professional reasons," such as "when disclosure is necessary to prevent serious, foreseeable, and immanent harm to a client or other identifiable person," (NASW, n.d., 1.07). Even when a social worker may be ethically obligated to breach confidentiality in these types of extreme situations, the "least amount of confidential information" should be released -- only that which is relevant to the purpose at hand (NASW, n.d 1.07). Informed consent also comes into play with confidentiality, because the social worker is obliged to inform the client about when a breach of confidentiality might take place. The client must authorize any other information disclosures.

The NASW (n.d.) does an excellent job covering the multiple parameters of confidentiality, and it is one of the longest sections in the code of ethics. For example, the NASW (n.d.) specifically mentions avoiding talking about clients in public spaces including "hallways, waiting rooms, elevators, and restaurants," (1.07, i). Moreover, the NASW (n.d.) urges social workers to do their best to protect client confidentiality even when they are testifying in court. Social workers should not feel pressured to divulge any more than they need to under the provisions of the law.

4. (a) I do believe Phan has the right to confidentiality and that the social worker needs to proceed with caution instead of alarmism or paternalism. To genuinely protect Phan, the social worker can coax him into using safe sex until the underlying issues….....

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