Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
Ethical Boundaries for Healthy
Client/ Carer Relationships
Patricia Fronek PhD
background
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research conducted in QSCIS
real life issues
raise awareness of issues
it is important as consequences can be
serious
Spinal Injuries Association Conference 2009
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
what boundaries?
ethical boundaries
boundaries?
what are they?
why have them?
whose responsibility are
they?
putting it into practice
what are they?
• a boundary describes that line that
separates a professional relationship
from one where there is a conflict of
interest in social, sexual, religious or
business interests
• boundaries are the limits that allow
for safe connections between people
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
professional relationship is one
where
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a professional service is provided
particular skills are required
the relationship exists for a period of time
the service has a cost
codes of behaviour and conduct exist
professional not personal – you come together
for professional reasons
• bears responsibilities and expectations
regarding trust and ethical behaviour
when boundaries are violated
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exploitative
manipulative
coercive
deceptive
(intentionally or
unintentionally)
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
a professional relationship is
• ethical
• relevant to both carer and client and comes with
responsibilities
• a carer has professional responsibilities, standards and
ethical codes of practice
• a carer’s interests are to provide the best possible care
• a client’s interests are to ensure he/she receives the best
care possible
• overt that it is a professional relationship
• both to show respect, do no harm, know where the
boundaries are, and to behave ethically
ethical principles
AUTONOMY
the promotion of self- determination or the freedom of clients to
chose their own direction
NONMALEFICENCE
do no harm - includes refraining from actions that risk hurting
another whether this be intentionally or unintentionally
BENEFICENCE
to do good for others which includes clients, carers, colleagues and
your own role in a professional relationship
JUSTICE
to provide fair and equal treatment to others
FIDELITY
to make honest commitments and to honour these commitments
VERACITY
to use truthfulness in all communications
Spinal Injuries Association Conference 2009
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
lines are crossed most commonly
in the areas of
• intimate relationships
• pursuit of personal benefit
• how people respond to their own
emotional and dependency needs
• altruistic gestures
• responses to unanticipated circumstances
when the line is crossed
it causes harm to
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the person receiving the service
the carer
the organisation
harm is not always evident to
all parties
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
Ethical Relationships Boundary Continuum
under involved
over involved
Adapted from Davidson 2005
ETHICAL SPACES
client
family
professional
carers
friends
others
Spinal Injuries Association Conference 2009
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
you are mistaking me for my job
responsibility – whose?
• professional responsibility – there is a
power imbalance
• tipped in the community where services
are self-directed, in a person’s home –
other imbalances such as gender, age,
experience etc
• professionalism, quality of service, respect
and longevity is the responsibility of both
client and professional carer
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
crossing the line
friendship
• gets confused – role of friend or carer
• changes expectations of relationship – may not
be the same
• are all clients treated the same?
• exploitative
• can lead to unequal care
• can limit social contact to carers
• friends are not paid
• you can care strongly about another person and
maintain professional appropriateness
Spinal Injuries Association Conference 2009
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
sexual approach
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power imbalance – which direction?
thinking about emotional needs
deal with real feelings openly and honestly
what is acceptable in a workplace
longevity of care relationship
who could be harmed?
harm to others may be unknown
does it mean someone has to lie?
casket ticket
• what are some of the consequences?
• is it in breach of any code of conduct?
• how does this change the relationships
between client, carer and organisation?
• how would other clients view the impact of
the win?
• how would the family view it?
Spinal Injuries Association Conference 2009
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
doing extras
• understandable
• what are the implications for the care
staff?
• what are the implications for the person
receiving the care?
• what are the implications for the ongoing
care relationship?
• What are the relevant ethical principles?
ethical principles
AUTONOMY
• the promotion of self- determination or the freedom of clients to
chose their own direction
NONMALEFICENCE
• do no harm - includes refraining from actions that risk hurting
another whether this be intentionally or unintentionally
BENEFICENCE
• to do good for others which includes clients, carers, colleagues and
your own role in a professional relationship
JUSTICE
• to provide fair and equal treatment to others
FIDELITY
• to make honest commitments and to honour these commitments
VERACITY
• to use truthfulness in all communications
Spinal Injuries Association Conference 2009
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
confidentiality
• needs to be safety
and confidentiality
• responsibility of both
parties to understand
these boundaries and
ethical requirements
• all care is packaged
according to
individual need
choices
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
ethical care means
• friendly and respectful behaviour
• are aware of the degree of involvement in
a person’s life
• take responsibility
• is not always clear cut or easy to negotiate
• thinking about boundaries
ETHICAL SPACES
client
family
professional
carers
friends
others
Spinal Injuries Association Conference 2009
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
putting into action
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awareness
ask for a copy of agency code of conduct
think ethically
problem solve
client and carer to reflect on ethical practice and role in
maintaining professional conduct
• open dialogue with the organisation
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Ethical Boundaries for Healthy Client/ Carer Relationships - Dr Patricia Fronek, Senior Social Worker, Queensland Spinal Cord Injuries Service
questions?
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