Effective Communication
Clients need to be supported by their carers using effective communication. For example, Braille would be appropriate to use with a blind service user, also the carer should be able to speak the same language as the client. This would aid effective communication. Also the carer taking positive body language would help the client understand. The carer needs to speak clearly and use effective language, for example if the carer was talking to a small child, long words would not be effective, and if the carer was talking to an elderly lady who was hard of hearing, a slow clear voice would help the lady understand. Minimal use of jargon that a service user would not be able to understand would make it easier for a client to understand. Also if a client speaks a different language, a translator would be needed so that the client understand what is being said.
There are also many different principles which are needed for use in care work. They are a basic set of guidelines by which the care workers need to adhere to.
These are important as they make sure the care workers client is receiving the best care as their carer is following the principles which are central to care work because they make sure clients are receiving the best care.
Autonomy
A service user has the right to autonomy under the Human Rights Act; this means that they have the right to do as he or she wishes, also the independence and self-determination to do this. Enhancing autonomy is essential to care work because it gives the client the power to live their live as they wish. However, autonomy does not mean bending to clients every whim. For example, if a social worker was caring for a client who was depressed, she may think that if he was to socialise he would stop feeling so lethargic, and begin to feel better. The client may be averse to this at first and therefore not wish to join in these activities; however the social worker would be able to offer many different types of social activities, as this would enhance his autonomy.
Acting in the best interests of a client
A carer must always act in the best interests of the client. This means that the carer always puts the interests of the client first, and will do anything to make sure that the client has his rights upheld. This could mean that the carer always makes sure that the client is always safe, or that the client can communicate effectively to convey their needs. The client will therefore always be well cared for as all his needs are being met. This could be linked to care practice, for example protecting children or the elderly, as it means that the client is always safe and well cared for, this means that the child or the elderly client is not suffering any abuse, either sexual physical or mental.
Independence
Independence is an important part of care work, Independence means that the client can do things for themselves and retain autonomy. There are many ways in which a carer can help the client retain their independence, one of these is by offering community care to the client. For example an elderly person living on their own, but doesn’t want to leave their home would benefit from community care, this could mean that the elderly person has meals on wheels delivered to them, or that they have a cleaner to help them with their housework. Also a client suffering from MS might benefit from someone to help them bathe and dress in their own home and to care for them. People who have community care also benefit from the company that they have with the people who care for them.
As is said in the current green paper report, the social care system is changing to help people retain their independence, for example, direct payment helps people have their benefit money wherever they need it, and this means that the client is able to do whatever they want, whilst knowing they can have the money to do it wherever they go.
People with disabilities are also being encouraged to work if they wish, this means that they are able to retain their working life and also receive the benefits of working.
The government at the moment is also campaigning to keep health services local, this means that people are more likely to be able to get to their local doctor or hospital alone and be able to take care of themselves in this way alone.
Paternalism
Paternalism in the interference of a care worker with a client. This is usually against the clients will. This interference is usually justified by the fact that the client will be better off. This usually means that a persona autonomy is restricted to prevent self harm or promote the persons well being. For example, if a person is mentally unwell, the Mental Health Act (1983) means that the person can be taken into a mental health ward against their will. The carer must put the best interests of the client first, even if this is against the clients will.
Respect for persons
As a social worker, it is not just the clients which the carer needs to respect; colleagues should be treated with respect and their views taken into judgement.
Clients should also respect the social worker; it’s a two way thing that clients should treat the social worker with respect and not intimidate or discriminate against the social worker.
For example, a client should not discriminate against the social worker because of their skin colour any more then the social worker would do for the client.
I will now give an explanation of Utilitarianism and Deontology
Deontology
Deontology is the theory that states the action is right or wrong, this means that the actions is wrong or right not the consequence of the action. Deontological theories say that when you are acting in regard to duties and rights you are acting rightly. This means that duties and rights are the way in which we measure right and wrong. Duties and rights are Immanuel Kant was identified with Deontological ideas. He said that every person has the right to dignity, and therefore entitled to respect. He would say that this respect should be shown by never using people to achieve a persons own goals or ideas. Deontological theory needs a degree of “weighing up” this means that we must weigh up what we think is right and wrong.
Deontology also says that an action is right if it respects human rights. This is sometimes referred to as “libertarianism” this is a theory that people should be free to do what they like as long as the individuals actions do not affect another.
For example a deontologist’s point of view may say that lying is wrong, even if the outcome is good. The opposite of Deontology is consequentialism. This is where the action is not held as morally right or wrong, it the consequence, For example, it is morally right to lie, if the outcome is favourable.
An example for social care work could be telling a clients family that he has cancer against the clients will. This could mean in the end that the client’s family helps the client in his last months and it helps the client feel better, because he didn’t have to break the news to his family himself, but this would be wrong in a deontologists point of view because the carer was going against the clients will and this means that even though the outcome is favourable the action is wrong, and so the entire thing would be deemed unethical.
There are some problems with deontological systems though. One of these is that there is no absolute way to resolve conflicts between two or more moral duties. For example, it is against the moral system not to lie, but also to protect a client from harm. But for example, if a social worker had to choose to lie to protect a client from harm, this would mean that he or she breaks one of the moral codes. For example if to keep a client from using drugs, the social worker could start proceedings to take the clients children into care. The social worker could know that the children will probably not be taken into care, but this could shock the parent into stopping using drugs.
The usual response to this dilemma is to choose “the lesser of two evils”. But this would mean looking at the consequences. This would mean that therefore the decision is not being made from a deontological perspective
Another problem with this ethical theory is which duties we all should follow, without worrying about the consequences. For example the duties which may have been valid in the 1700s are not always useful now, but which duties should be abandoned?
Some of the critics of deontology say that the deontological moral systems are simply undercover consequentialist moral systems. The argument which was put forward said the duties which deontological systems follow are those which over time have proved to be having the best outcomes. After many years they become custom as people do them without thinking about the consequences, they are simply thought to be right.
Utilitarianism
This is a theory put forward by Jeremy Bentham and James Mill. It proposes that actions should be held as the greatest happiness for the greatest number of people. It balances greater and lesser good. Utilitarianism is an example of consequencalism. In a utilitarian point of view the best actions are those that do more good then bad, so whether you are paying a small kindness to someone or deciding to wage war on another country is said to be moral or not depending on if the outcome provides the greatest amount of happiness to the greatest amount of people. Utilitarianism does not depend on principles and duty like Deontology, it does not think that it is natural that some things are good and some things are bad, and if that means that the individual must sacrifice his own happiness for the majority, he should do so as this means an increase in general good. For example, if there was a man dying, it would be acceptable to donate his organs to people who needed them desperately, despite his wife not wanting to have them given away, because this would give the greatest amount of happiness to the organ receivers and their families
However, there are some problems with utilitarianism, for example, if a surgeon has 6 patients, 5 of whom need major organs, such as a liver kidneys gallbladder etc, and one who has just come in to have his appendix removed, according to utilitarianism it would be right to kill the 6th man and give his organs to the others, because if he didn’t the other 5 people would die. Therefore it would obviously violate the rights of the sixth man, but by doing this the surgeon is saving 5 people and therefore violating the sixth man is what we should do.
However we know that this is not ethically right, and also it would be illegal. This rule if it was applied in society, would stop people from going to use health care, a lot of operations which are expensive would put a drain on health care services
In a care setting there can be many different ethical dilemmas.
An ethical dilemma is a situation in which moral duties are against each other. In these situations it would mean that obeying one of the moral duties would mean not obeying the other.
For example, there could be a dilemma in the rationing of resources. This is where there are not enough resources to meet the needs of all the people who need treatment. There are many types of rationing in healthcare resources, for example, by the persons social characteristics, it could be argued that if one person is a heavy drinker and another is tee-total, the heavy drinker is less worthy of a liver transplant if one was needed . This is an ethical dilemma as a carer has to decide which person is more worthy of treatment, and why. It could be that they are both equally in need of treatment, but because one is more likely to be successful, it could be argued that the treatment should be given to that service user.
If there was a child who was in need of a blood transfusion, and also a man who needed the same, and there was only enough for one, would the carer give it to the middle aged man or the young child who had her life before her? This would be an ethical dilemma (because there are two ethical principles in conflict) though, because the mans family could be dependant on him; he could also be a carer for someone. Would it be ethical to give the child the blood because she was younger? Or would it be ethical to give the man the blood because his family relies on him? This is linked to a code of practice known as the Quality assisted life years. This means asking who as the more quality years of life left, who has the better family background. Therefore if the child had a terminal illness, and only had a few years left to live, it would mean that she would have less years left to live, and therefore mean that she would not have the blood transfusion.
This could go against some laws however, it goes against the founding principles of the NHS, for fair and equal treatment for everyone, also it goes against the human rights act, which states everyone is allowed to receive fair and equal treatment regardless of their colour, sexuality, gender or age.
Also there can be ethical dilemmas involved in the issue of confidentiality. The data protection act covers the fact that all private information must not be shared. The information must be distributed on a “need to know” basis, this means that the people who know about it, know about it essentially. This can be an ethical dilemma, as information may need to be shared to keep clients or those around them safe.
For example if a man has been diagnosed as HIV positive, he has the right to keep this confidential. However he has confided in the carer that he has still been sleeping with his partner. Would it be ethical to divulge this information to her, in the hope that it would prevent her from contracting HIV? This is an ethical dilemma, as the information has to be kept Private, but the partner is in danger. All organisations have policies on sharing information, for example, article 2.3 in the social workers code of practice says “respecting confidential information and clearly explaining agency polices about confidentiality to service users and carers” This would mean that the carer could not tell the partner. Also the Data Protection Act does not allow carers to share information which would be classed as sensitive or which is confidential, such as home addresses or any medication the individual is taking; this is because it says in the Data Protection Act that “data can be collected for limited purposes”. There are also codes of practice which forbid telling. For example, the Nursing and midwifery council states clearly that workers should protect people’s confidentiality. (As stated here http://www.nmc-uk.org/nmc/main/advice/ukccPositionStatementOnComputerConfidentiality.html)
There are also dilemmas involved in identifying the best interests of clients. Identifying the best interests can be hard as there may be many conflicting ideas. The client may not wish to be treated in a certain way, and they have the right to refuse treatment because they have the right to autonomy. This is because many clients may not wish to be cared for in the way that is “best” for them. It can be hard deciding whether to help a client without their permission or if they should have their own way. It is illegal to treat a client without their permission, except under the mental health act. This is because the mental health act allows the carer to make the decisions if the client is unable to decide what is best for them.
For example, if an elderly lady wanted to live alone in her house, but was no longer able to take care of herself for example, cleaning her house, cooking for herself, cleaning herself, would it be ethical to take her out of her house that she had lived in for most of her life? However the care that she needs is only available in a rest home, and she is in danger of hurting herself. Would it be ethical to do this in her best interests? The Human Rights Act states that the woman should be able to have her own way, the right to independence and also this means that she has the right to autonomy. However there is the NHS and community care act of 1990. This act states that the individual has the right to :-
Equipment or adaptations to individuals' homes.
Helping with everyday tasks.
Helping to come to terms with individual problems.
- PHYSICAL AND / OR NURSING CARE
Helping with illness and disability.
Maintaining a reasonable quality of life and compensating for the costs of disability.
Accommodation which is adequate and affordable.
Taking part in community life.
- ACCESS TO RECREATION, LEISURE AND WORK
Living as full and an active life as far as possible.
This means that the carer could produce community care. Community care can be taken from many different sources. It can be from neighbours friends or family or from public organisations for example district housing authorities. It can also be provided by voluntary groups such as age concern, MENCAP or local support groups, also private companies such as meals on wheels, or a private cleaner. Therefore the woman could stay in her own home, whilst being safe and secure. She would be able to take care of herself in some ways, whilst getting the help that she needed.
There are many different types of legislation which are central to care work.
One of these is the Mental Health Act of 1983. This act is used in relation to people who are mentally ill or disabled. If a person is proved to be mentally ill and present a risk to themselves or others, they are allowed to be taken into care under this act.. If they have committed a criminal offence they can be sent to a prison. Being in one of these Hospitals in a severe restriction on peoples freedom and as such they appeal against being imprisoned. These appeals are brought before a tribunal. This is central to ethical issues, as these people are having their human rights taken away such as the right to independence and autonomy. Also the right to freedom is taken away., but they are also being institutionalised as they are a danger to themselves and others. It also helps them to be able to become mentally well again, and this leads to them being well, therefore it is in their best interests, is autonomy more important or the rights of the community to live without a person who may be a danger to themselves and the community?
There is also The Children’s Act of 1989. This act means that children have the right to be protected from “significant harm” at the hands of others. This is defined by the courts if social services decide to get involved. The harm could be the parents neglecting or abusing their children, or the children themselves being out of control or breaking the law by being involved in drugs or prostitution. This Act concentrated more on parental responsibly rather then parental rights. This means that children are empowered and not treated as property which their parents have rights over. This relates to ethical issues, as it is linked to utilitarianism. This means giving the greatest good to the greatest amount of people. This act protects the children, and makes sure that they are cared for properly and not abused. It also makes sure that places of education do not discriminate against children of different colours or religions or on account of their disabilities. The ethical issues surrounding this Act is who’s rights are more important, the right of the parent to have their child with them, or the right of the child to live happily and without fear of abuse. This also applies to schools
The Data Protection Act of 1998 means that service users have a right to keep private information confidential, but it also means that they have a responsibly in relation to the rights of other service users. The confidentiality must be kept within certain borderlines, and can be broken when other service user’s rights come into conflict. Certain information may need to be passed to a senior member of staff when there is someone in danger. This relates to ethical issues as it is difficult to decide when confidential information should be shared, as described in my ethical dilemma above.