Observing Different Faiths,Learning About Ourselves: Practice with Inter-married Muslims and Christians

Abstract

Advanced care planning and end-of-life decision making are part of contemporary debates about death and dying. A data-mining study reviewing medical records of patient deaths in hospital investigated these issues and the utilisation of social work services. Findings indicated that the majority of records included some form of documentation about end-of-life care, including cardio pulmonary resuscitation (CPR) orders and that family members and surrogate decision makers were more likely to be consulted than patients about these plans. The incidence of referrals to social workers was found to be highest “out-of-hours”. Key social work interventions were identified, including establishing the reliability of surrogates' decisions through social work assessment. This paper discusses elements that contribute to a supportive environment for patients and family members to facilitate the decision making process, including the need for a broader ethical discourse to accommodate the increasing complexity of end-of-life decision making in hospital settings.     

Explicit Versus Implicit Family Decision-Making Strategies Among Mexican American Caregiving Adult Children

Changing U.S. demographics make it increasingly vital to investigate experiences of Latinos caring for aging parents, with specific emphasis on how these families, who often value family closeness, make decisions about caregiving. This study investigates relationships among use of implicit versus explicit decision-making strategies, generation since immigration, and orientation toward family. Findings suggest that those with more recent immigration to the United States were more likely than those who immigrated longer ago to describe family decision making about their parents' care as implicit. Those that were classified as using predominately implicit decision making were also found to be not significantly different from those classified as predominantly explicit with regard to their overall support of a collective orientation toward family. There were exceptions to this, however, regarding two specific aspects of orientation toward family: engagement in shared activities with family members and avoiding family conflict by making choices that are consistent with the family values. In both cases those categorized as implicit expressed stronger endorsement of these specific values. These findings suggest that the relationship between family decision-making strategies, generation since immigration, and orientation toward family is more complex than suggested previously in the literature. Implications for future research and practice are offered.     

There are no Answers,Only Choices: Teaching Ethical Decision Making in Social Work

Abstract

In teaching students about ethical decision making in social work, it is essential that the students are able to recognise the moral implications of their work and develop a deep understanding about ethical issues and their personal responsibility for making ethical choices. Thus, more than a “how to do it” approach is needed and teaching students about values and ethics is an essential thread that runs through our experience-based social work education program. The present paper describes a learning unit that sought to teach students about ethical decision making as a critical thinking process and, in so doing, to integrate students’ knowledge and experience of values, ethics, policy, and research in the final year of study. The relationship between values, ethics, policy, research, and social work practice provided an ideal context within which students could learn to integrate their knowledge and experience and apply it directly to their fieldwork practice. The paper ends with our critical reflection on this teaching experience and a critique of decisionist ethical frameworks.     

Mental health issues and the foster care system: an examination of the impact of the Adoption and Safe Families Act

Although marriage and family therapists are being called on to help at-risk families, some say that clinicians have insufficient knowledge about the impact of policies on families involved in the foster care system. The purpose of this qualitative investigation was to identify how the Adoption and Safe Families Act informs decision making, to recognize trends in decisions regarding termination of parental rights of parents with mental health issues, and to explore treatment issues of families involved in the foster care system. Results indicate that court cases decided after the implementation of the Adoption and Safe Families Act are likely to result in termination of parental rights. Implications for clinicians and researchers are discussed.     

Ethics of care in action: Overview of holistic framework with application to employee engagement

At the heart of public relations is the act of creating relationships that facilitate dialog, collaboration, and ongoing trust. This paper aims to conceptualize a framework based on ethics of care (EoC) that harnesses these core underpinnings, which propel the public relations industry, to enhance employee engagement. The ethics of care applied to employee engagement (EoCAEE) framework combines the success found within the EoC phases, along with the landscapes presented in the Applied Model of Care Considerations (AMCC), to ensure ethical, holistic decision making. EoCAEE repositions employee engagement as an ethical practice for organizations to prioritize with actionable steps.     

Dignity in dementia: Person-centered care in community

Drawing on Kitwood's [Ageing Soc. 13 (1993) 51] theory of person-centered care and the interpersonal process of caregiving, this article offers an alternative to the image of the family caregiver as victim through an exploration of the lived experience of caring for a person with dementia in community. Extending care beyond coping, the act of giving care is promoted as a worthy activity and reciprocal social opportunity. Three nonfamily caregiver “portraits” are offered in an arts-informed representational form. The relational processes of caregiving are explored from the vantage point of personal experience and theoretical knowledge. Dignity emerges as the resonant quality, essential value, and guiding principle in an ethic of dementia care. Implications about the direction of research about care and caregiving and research accessibility and usefulness are explored.     

Too sick to move: distant ‘crisis’ care in transnational families

This paper examines the crisis of acute and chronic illness, death, and dying in transnational families. These are the stages in the family life-course when physical co-presence is required to deliver hands-on care and intimate emotional support for the sick family member. It is a time when distant kin feel they need ‘to be there’, including for their own sense of well-being. This period of ‘crisis’ (in the anthropological sense) makes visible all of the impediments to transnational family caregiving that often remain hidden during those periods when ‘routine’ forms of distant care are adequate. Of particular relevance are the macro-level factors generated by national borders and the policies that define them, including those that govern employment, travel, visa, health, and aged care provisions. It is in these family life phases of crisis that nation-state structures can work to constrain individual agency and rights, making compellingly evident the growing need for transnational structures and policy. At issue are the largely invisible (in a policy sense) but increasingly common micro-level responses of family and individuals that characterize ‘crisis distant care’, which are characterized by the urgent need to visit and to intensify use of ICTs. The paper examines the experiences of migrants living in Australia who are trying to care for acutely unwell family members abroad.     

The Subjectivity of Fairness: Managerial Discretion and Work–Life Balance

We use organizational justice theory to examine how perceptions of fairness affect the decision‐making process of line managers. In‐depth interviews were conducted with 35 Irish managers to explore how managers make organizational allocation decisions in cases where it is impractical to offer work–life balance accommodations to all employees. The findings suggest that firstly, managers construct the ‘life’ aspect of work–life balance within a heteronormative framework, where the emphasis is on caregiving and most usually parenting. Secondly, managers actively use their decision‐making powers around both formal and informal work–life balance supports to minimize injustice within their departments. By bringing together ideas about organizational justice and managerial decision‐making, we indicate how managers determine fairness through a decision‐making process narrowed by embedded gender role beliefs. Implications for future research and practice are discussed.     

An analysis of dyadic dominance in family decision‐making among older adults

Growth of the population aged sixty‐five and over is a significant trend in the sociodemographic structure of society. As a result, this age group is receiving increased attention from governmental and business decision‐makers. Little is known, however, about intra‐family decision‐making among members of this group. This paper presents an analysis of the determinants of husband and wife dominance in family decision‐making. The data indicate that dominance by the wife in decision‐making is related to the wife's positive self‐concept concerning the ability to make decisions as well as a “rub‐off” effect on the wife by the husband's self‐concept. Work history of the husband, in turn, contributes to his self‐concept. There were, however, no significant relationships between educational levels of either spouse and decision‐making dominance.     

Organizational ethics, decision making, undecidability

In this paper we develop a conceptualisation of organizational decision‐making as a practice that is, necessarily, ethical. The paper starts with a discussion of the notion of decision‐making as it relates to organizational rationality and the relationship between management and control. Drawing on Derrida's discussions of undecidability and responsibility, we suggest that as well as being able to consider organizational decision‐making as an instance of (albeit bounded) rationality or calculability, it can also be regarded as a process of choice amongst heterogenous possibilities. On that basis, we follow Derrida in arguing that for a decision to be considered an instance of responsible action it must be made with neither recourse to knowledge of its outcome nor to the application of pre‐ordained rules. Illustrating our argument with a discussion of Eichmann's ‘I was just following orders’ defence, we suggest that rules for ethical decision making, rather than ensuring ethical outcomes, can work to insulate organizations from moral responsibility. We conclude with a discussion of ethics and democracy in relation to responsible decision making in organizations.     

The Role of Ethical Theories in Decision Making by Social Workers

This study analyses the arguments provided by a convenience sample of 62 Israeli social workers for their preferred ethical principles in terms of ethical theories. Content analysis of arguments given in four different contexts shows that the large majority of social workers in the study based their arguments on either deontological or utilitarian ethical concepts, less frequently using concepts from virtue theory, rights theory and care theory of ethics. However, the analysis reveals a discrepancy: when social workers were requested to justify their rank ordering of ethical principles without reference to a specific practice situation, they most frequently preferred concepts reflecting deontological theory of ethics, such as right intention, universalism, and duty. In contrast, when confronted with a specific practice situation, the social workers' most frequently chosen concepts were relating to results, consequences, and utility, concepts identified with the utilitarian theory of ethics. In view of the findings, the need for more thorough knowledge of a variety of ethical theories and their potential role in ethical decision making in social work practice and education are discussed.     

A Systems-Crisis Approach to Family Treatment

This paper presents a model which integrates a wide range of possible interventions using family treatment and provides a method of differential decision making with regard to the intervention to be used in a given case. The model uses an ecological perspective and draws on concepts from general systems theory and crisis theory. A number of case examples are provided to demonstrate how the model has been applied in a clinical setting.     

The family caregiving career: implications for community-based long-term care practice and policy

Informal (i.e., unpaid) long-term care for disabled older adults is often chronic, but it is only recently that research has considered the longitudinal implications of family caregiving. In particular, investigators have conceptualized caregiving as a "career," and within the caregiving career, a number of diverse trajectories and transitions can occur. Following a summary of these findings, this paper considers how longitudinal caregiving research can influence and potentially address key policy and practice concerns, especially in the delivery and support of community-based long-term care (CBLTC) services. It is suggested that with the refinement of the informal long-term care literature, existing policy and practice to support caregiving families can be similarly advanced.     

Professional Decision Making on Elder Abuse: Systematic Narrative Review

Social work and health care professionals internationally are recognizing the need to understand and respond to the abuse of older people. Policy and guidance have identified processes but definitions of key concepts remain problematic, and the literature suggests that practitioners and agencies have little insight or guidance for decision making. Nine bibliographic databases were searched for studies on professional decision making regarding abuse of older people. Relevant studies retrieved were appraised for quality using explicit criteria. The findings of the 19 articles meeting the inclusion criteria were synthesised using a structured narrative approach. Common themes identified were abuse factors, situational factors, and broader contextual factors. Abuse factors relating to risk levels and client vulnerability were central; age, gender, and health status were considered as key indicators of vulnerability. The opinion of adult protection workers about the potential effectiveness of their intervention was a factor in deciding about responding to alleged or suspected abuse. Professionals struggled with complex ethical dilemmas created by elder abuse, particularly when the victim did not want an investigation. Making objective judgements was difficult when faced with complex family and contextual factors. A structured approach to narrative synthesis of a diverse range of studies retrieved through an explicit search and inclusion process provided a useful summary of key issues for practice and identified gaps in the research literature.     

The effects of federalism on policies for care of the aged in Canada and the United States

Debates about who should care for the elderly often center on the relative responsibilities of the state and family. In federal societies such as Canada and the United States, however, multiple governments are involved. This article compares and contrasts federalism in these two nations and its effects on the division of fiscal, administrative, and programmatic responsibilities for care of the aged between the national and regional (i.e., state, provincial) governments. Two major policy arenas, health care and social services, are examined, with particular attention focused on the roles played by the nongovernmental sector. Because most care of the aged is provided informally--a situation firmly rooted in the value systems and public policies of both nations--national and regional policies that assist family caregivers directly are examined. Policymakers at the regional level have been more active and often more innovative in constructing policies that are supportive of family caregiving, but in general, few programs of direct assistance exist in either nation and these largely depend on their geographic location. The article concludes with a discussion of the continued effects of federalism for future policies affecting care of the aged and suggests some approaches that can be undertaken to empower families in their caregiving roles.     

Computer Assisted Decision Making

Summary

It is frequently argued that computerized decision support lends itself more easily to structured than to semi- or unstructured decisions. This paper discusses decision tasks of human service practitioners and surveys emerging research in decision theory and associated decision applications. It provides examples of an Information System, a Decision Support, and an Expert System, and examines under what conditions they can facilitate decision making in human services. A number of future issues and concerns are addressed, including ethical and legal questions, and computer literacy in human services education and practice.     

Family decision making in child welfare: challenges in developing a knowledge base for practice

Over the past two decades, engaging families in decision‐making has grown in popularity across child welfare systems internationally. The family group conference in particular has generated interest as a practice model that facilitates broader family engagement in care and protection. As the practice has flourished, research has been undertaken to strengthen the knowledge base and to support the introduction of family engagement strategies across jurisdictions. This paper examines the recent research relating to family engagement strategies in child welfare and explores the ways in which family involvement in decision‐making can be incorporated into emerging protective practices. Copyright © 2010 John Wiley & Sons, Ltd.     

Making waves: trauma and ethics in the work of lars von Trier

The cinema of Lars von Trier can be characterised in diverse ways, but one of the most striking and memorable aspects of his work in the “Europa trilogy” (Element of Crime 1984; Epidemic 1987; Europa 1991) and the more recent “Goldheart trilogy” (Breaking the Waves 1996; The Idiots 1998; Dancer in the Dark 2000) is the centrality of trauma in both narrative and form and the corresponding emphasis on ethics. Each of these trilogies sets out to scrutinise ambiguities and ambivalences around binaries such as good/evil and guilt/innocence through the exploration of socio‐cultural trauma such as war and plague in the earlier trilogy, and through more individually‐inflected trauma in the latter one. Interestingly, von Trier flags the inter‐relation between the success of the ideals that are central to his narrative forays and the gender of his protagonists (Smith , p. 24). How, then, might it be possible to make sense of the slippages and confusions implicit in von Trier’s film‐making in order to discern his ethical concerns, and how might these concerns be articulated through cultural assumptions about gender and ethical identities? This essay explores the ethical assumptions and imperatives that mark out von Trier’s work, signalling the role of the spectator in the formation of the ethics of his cinematic project. Drawing on psychoanalytic theory and feminist notions of ethics, the paper asks whether von Trier’s work is merely to be framed in terms of postmodern provocation or whether his manipulations of cinema and all its accoutrements ought rather to be understood in terms of a radical artistic endeavour designed to foreground the importance and potential of cinema as a site of scrutiny of the inter‐relation between ethics, trauma and gender.     

RESOLVING ETHICAL CONCERNS IN CLINICAL PRACTIVE: TOWARD A PRAGMATIC MODEL*

A pragmatic model is proposed for use in resolving ethical concerns and dilemmas in clinical practice. It encompasses five decision bases that therapists may draw on for the kind of comprehensive analysis that is necessary for reaching a defensible decision. The decision bases are: (a) theories of ethics; (b) professional codes of ethics; (c) professional theoretical premises; (d) the sociologal context; and (e) the personal/professional identity. The model is applied to five actual cases offered by several therapist who experienced ethical concerns with them. The case analyses demonstrate the model's utility for decision making and for prevention of ethical problems.