Ethical Dilemmas in Social Work and Human Services

This article discusses the ethical dilemmas faced in social work and human services, focusing on a case study involving an individual refusing treatment. It explores the principles of beneficence, non-maleficence, autonomy, and justice, and suggests how to strike a balance between these principles. The article concludes with recommendations on resolving the ethical dilemma.

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Communication Skills in Social Work and Human Services
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Introduction
Ethical dilemmas often present themselves as almost impossible situations that involve making a
choice between two options and neither of these options resolves the situation in an ethically
acceptable manner.
Alison's condition is a typical ethical dilemma because Alison feels there is nothing wrong with
her and she declines being admitted to an Eating Disorder Unit. She even goes ahead and asserts
that there is nothing wrong with her. Her parents, on the other hand, are compelling her to eat
because they feel she is not in a position to make a rational decision on her own despite her age.
This case will be analyzed by employing the four principles of ethics of service; the principle of
beneficence, non-maleficence, autonomy, and justice. This write-up seeks to determine which
principle applies in this particular issue and what other principles suggest on the same as well as
their implications on the conflict and in that way determining how the situation can be resolved.
Principle of beneficence
Beneficence is an ethical principle that puts emphasis on the idea that a nurse or other medical
staff should always seek to promote good (Will, 2011). The term doing good has been used to
imply doing what is best for the patient and not any other party. Here nurses often see the patient
and often think about the long-term outcomes of the patient, whether or not the patient will be
okay in the long run. There is always a challenge that is associated with this principle. The
challenge is that there is always a challenge of determining what is best for the patient. This is so
because the term good to some patients might involve allowing them to die while to others the
term good might imply prompting the patient to under extremely difficult procedures in order to

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save their life. In such cases, the nurse often considers what the patient wants and some of the
immediate needs for the betterment of their life.
Principle of non-maleficence
This principle is based on the fact there should be an obligation not to intentionally inflict pain
on others (Vansteenkiste, Williams, Resnicow, 2012). It entails the following details; do not kill,
do not incapacitate, do not cause offense and do not cause pain and/or any form of suffering to
an individual intentionally.
Principle of justice
This principle requires one to be in a position to equally distribute benefits, risks, costs as well as
resources. Some of the arguments that this principle supports are outlined below; each person
should have an equal share, this share should be based on the needs of that particular individual,
this should also be based on the effort and according to the responsibility of the persons and it
should also be based according to merit (Mawere, 2012).
Principle of autonomy
This principle suggests that every person is in control of their own thoughts and actions and can
be motivated by some critical internal forces such as choice and reflection (Cummings &
Mercurio, 2010). Autonomy is basically meant to protect and individuals choice as well as their
freedoms regarding certain issues.
It is recommended that there should be a respect for patients autonomy, thoughts and actions of a
patient should be respected and well considered before any decision is made concerning
something that is likely to affect them.

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Which principles apply to the case and why
The principles that apply in this particular case are the principles of autonomy, beneficence and
that of non-maleficence.
The principle of autonomy applies in this particular case because it suggests that every person is
in control of their own thoughts and actions and can be motivated by some critical internal forces
such as choice and reflection. In this particular case, Alison does not want to get admitted to the
Eating Disorder Unit because she feels she is okay. Despite the fact that her parents feel she
should be admitted, she refuses to go. Nurses have an obligation to respect her autonomy; her
thoughts and actions (De, 2011).
The principle of beneficence also applies in Alison’s case. This principle suggests a nurse or
other medical staff should always seek to promote good. The term ‘good’ has been used to imply
doing what is best for the patient and not any other party (Page, 2012). In Alison’s case, her
parents feel that she should be admitted to the Eating Disorder Unit because it is for her own best
interest, her parents say that she is not in a position to make a rational decision on her own and
being admitted is the best thing for her.
The other principle that applies, in this case, is that of non-maleficence. As mentioned earlier,
this principle suggests that there should be an obligation not to intentionally inflict pain on
others. According to this case, Alison insists that she is okay and that nothing is wrong with her.
Putting her in the Eating Disorder Unit will be ignoring this particular principle.
Do the other principles suggest the same action or are there applications in conflict

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Other principles such as that of justice and non-maleficence do not directly apply in this case.
They therefore do not suggest any action but rather are applications in conflict.
How is the right balance strike between the requirements of the different principles
The right balance can be strike by considering the principle of beneficence more in comparison
of other principles. This principle suggests that an action should be taken that which involves
doing what is in the best interest for the patient. Based on this case it is clear that what is in of
the best interest of Alison is admitting her to the Eating Disorder Unit. This is so because she has
some really serious complications and she needs immediate attention.
What other principles suggest and how this issue can be resolved
Based on this case, we notice that it is an ethical dilemma because each of the principles says a
totally different issue that is morally right (Avasthi, Ghosh, Sarkar, Grover, 2013). This issue is
quite complicated in the sense that her parents want Alison to be admitted in the Eating Disorder
Unit while Alison is against the idea because she feels she is okay and that nothing is actually
wrong with her.
This issue can be resolved by considering the principle of beneficence more in comparison of
other principles. This principle suggests that an action should be taken that which involves doing
what is in the best interest for the patient. Based on this case it is clear that what is in of the best
interest of Alison is admitting her to the Eating Disorder Unit. This is so because she has some
really serious complications and she needs immediate attention. Despite the fact that the
principle of autonomy contradicts this principle, the principle of beneficence should be
considered as it seeks to act on what is in the best of interest of the patient no matter what the
circumstances (Meert & Sarnaik, 2010).

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References
Avasthi, A., Ghosh, A., Sarkar, S., & Grover, S. (2013). Ethics in medical research: General
principles with special reference to psychiatry research. Indian Journal of
Psychiatry, 55(1), 86.
Cummings, C. L., & Mercurio, M. R. (2010). Autonomy, beneficence, and
rights. Egyptian_Pediatric yahoo group, 31(6), 79-86.
De Roubaix, J. A. M. (2011). Beneficence, non-maleficence, distributive justice and respect for
patient autonomy–reconcilable ends in aesthetic surgery?. Journal of Plastic,
Reconstructive & Aesthetic Surgery, 64(1), 11-16.
Mawere, M. (2012). Critical reflections on the principle of beneficence in biomedicine. Pan
African Medical Journal, 11(1), 78.
Meert, K. L., & Sarnaik, A. P. (2010). Choosing between death at home or in the hospital:
Respecting the principle of autonomy. Pediatric Critical Care Medicine, 11(3), 438-439.
Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision
making?. BMC medical ethics, 13(1), 10.
Vansteenkiste, M., Williams, G. C., & Resnicow, K. (2012). Toward systematic integration
between self-determination theory and motivational interviewing as examples of top-
down and bottom-up intervention development: autonomy or volition as a fundamental
theoretical principle. International Journal of Behavioral Nutrition and Physical
Activity, 9(1), 23.

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Will, J. F. (2011). A brief historical and theoretical perspective on patient autonomy and medical
decision making: part I: the beneficence model. Chest, 139(3), 669-673.