The Ethics of Caring
Beyond Personal &
Professional Decision
Making
SE4A Conference 2009
Charleston, SC
Presenters: B. Gordon & M. Dobson
What is ethics?
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Ethics refers to well based standards of right
and wrong that prescribe what humans ought
to do, usually in terms of rights, obligations,
benefits to society, fairness, or specific
virtues.
Ethics refers to the study and development of
one's ethical standards
Is legal the same as ethical?
Barbara Gordon & Molly Dobson
What is ethics?
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The enterprise of disciplined reflection on
moral intuitions and moral choices.
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Moral values are examined
What ought to be done in a given situation.
Ethical principles form moral choices as
persons act as moral agents.
Various Professional disciplines have
individual Codes of Ethics
Barbara Gordon & Molly Dobson
Ethics in the Service Environment
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The Health Care & Human Service
Environment hosts many professional
disciplines.
Each discipline’s codes of ethics have similar
principles and they are generally not in
conflict but supportive and mutual.
Quality in the human service and healthcare
service environment does not only include
technical and service quality, but also ethical
quality.
Barbara Gordon & Molly Dobson
Code of Ethics
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Individual/Personal value system
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Personal Standards – Respect, Trust and
Confidence
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Professional/Discipline Code of Ethics
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Based on various ethical theories
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Used as tool to define and understand crisis
in decision making and resolve differences.
Barbara Gordon & Molly Dobson
Guiding Principles in Ethics
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Integrity
Objectivity
Professional Confidence
Confidentiality
Professional Behavior
Technical Standards
Source: Advancing Government Accountability
Barbara Gordon & Molly Dobson
The Healthcare/Human Service
Environment
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“In human service/healthcare the person’s
good is achieved across a spectrum of
biomedical, spiritual, functional, and
emotional needs. Thus, the provider
addresses the physical, psychological,
functional, emotional and societal needs of
individuals, families, and communities. Often,
ethical dilemmas arise because of the
necessity for making choices in how to meet
these human needs. Ethical principles &
theories both contribute to systematic
reasoning to achieve the good in decision
Barbara Gordon & Molly Dobson
making.”
The Healthcare/Human Service
Environment
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Clinical ethics versus institutional ethics
Value structure of an organization
Does not just depend on leadership
Ethics must be inherent in the organizational
culture.
Holistic systems approach.
Barbara Gordon & Molly Dobson
Organizational Culture
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“In any attempt to change the values of an
organization, whether it is through the education
of its participants in moral principles, or the
imposition of leadership committed to higher
ethical principles, the contents of the existing
organizational culture must be dealt with directly
for positive change to occur. Ignoring culture in
attempting to refocus the values orientation of an
organization is similar to ignoring causes and
treating symptoms.”
Mary Cipriano Silva, Ph.D., RN, FAAN
Barbara Gordon & Molly Dobson
Organizational Culture
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Values and ethics are not only central to
organizational culture but also to positive
organizational performance.
Institutions have ethical lives and
characteristics just as their individual
members do.
Must disengage behaviors and practices that
compromise the organizational culture or
causes the organization to become ethically
deviant.
Barbara Gordon & Molly Dobson
Organizational Culture: Building an
Ethics Infrastructure
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Conduct a formal process to clarify and
articulate the organization's values and link
them to the mission and vision.
Facilitate communication and learning
about ethics and ethical issues, including
values clarification and reflection on their
link to practice.
Create structures that encourage and
support the culture.
Create processes to monitor and offer
feedback on ethical performance.
Barbara Gordon & Molly Dobson
Organizational Culture: Building an
Ethics Infrastructure
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To prevent deviant organizational structures,
human service professionals should consider:
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extending their horizons and that of their staff
beyond their own discipline and attend business
classes and seminars on organizational ethics,
read business journals and books on ethics and
organizational structure,
understand that hidden behind many decisions they
make is an ethical issue waiting to be explored, and
Barbara Gordon & Molly Dobson
Organizational Culture: Building an
Ethics Infrastructure
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Healthcare and human service providers who
exist within an environment with positive and
effective ethical culture will typically not get
caught in the cross fire of administration, rules,
regulations, policies and practices, and/or
funding limitations that prevent people from
receiving the type of care that is available.
This type of environment will protect and defend
the human dignity of the professional and rehumanize the health or human service that is
being provide.
Barbara Gordon & Molly Dobson
Making and Ethical Decision
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Recognize the Ethical Issue
Get the Facts
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Relevant Facts
Individuals and groups with an important stake in decision
What are the options for acting?
Evaluate Alternative Actions
Make a Decision and Test It
Act and Reflect the Outcomes
Barbara Gordon & Molly Dobson
Approaches to Ethical Business
Decision-Making
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Utilitarian -Action that will result in the greatest
good for greatest numbers.
Moral Rights – Moral principles, regardless of
consequences. At times simply right or wrong.
Universalism- 1) Should decision apply to all
and 2) Are you willing to have rule applied to
you?
Cost-Benefit – Balance the costs and benefits
vs. not taking any action.
Source: Managementhelp.org
Barbara Gordon & Molly Dobson
Case Scenario
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Conflict between good practice and demands of
the agency.
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Jenny, age 50, has a client who is homebound and requires
care that at times may exceed the amount of time she is
allotted by her company in order to visit as many clients as
possible per day. Her company is paid a certain amount per
visit, plus a reduced rate for the cost of care. The company
wants her to spend less time per client so she can visit more
clients per day. Jenny insisted that client needs more care due
to limitations, but her company says she must finish her work
quickly and move on to the next client. Jenny’s job could be in
jeopardy if she doesn’t comply.
Barbara Gordon & Molly Dobson
Case Scenario
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Client Needs/Rights versus Public Good
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A client who visits a senior center on a regular basis
has flu like symptoms and possible H1N1. She tests
positive by her physician. There is concern for the
clients and public who have been exposed. You
must consider the health of others. How do you
handle the situation?
Barbara Gordon & Molly Dobson
Case Scenario
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Conflict between co-workers due to differences
in training, profession or responsibilities.
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A program coordinator of the local senior community center has
arranged for a large event that will be costly to operate over a
one week period. The staff has developed a budget and the
Finance Department has rejected the budget as too costly since
the cost will exceed the amount available in the aging budget.
Program staff is insistent that this event must take place to
meet performance on a grant that funds the agency. If the
event takes place, the agency may not have enough money to
pay for the event. How should staff handle this conflict?
Barbara Gordon & Molly Dobson
Case Scenario
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Conflict between serving or discontinuing services for a client
who will not follow care plan and protocols for program.
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Mr. Jones is 85 years old, single, lives alone and has no family or other informal support
system. He is in poor health with diagnoses of diabetes, high blood pressure, and COPD.
His health has been deteriorating and his ability to care for himself has been compromised.
His current care plan includes home delivered meals 7 days per week (frozen), personal
care, home making and transportation to the physician. Mr. Jones has a problem with
hoarding which makes it very difficult to provide care. He now has an obvious mice/rat
infestation. It has been difficult convincing Mr. Jones that he needs assistance with
clearing his home of clutter and addressing the mice problem. APS has been contacted on
many occasions but because Mr. Jones is competent and coherent, APS has not acted to
remove him from the home. “He chooses to live this way.” In-home services aides for
some providers have refused to go into his home and it has become very challenging to
serve him. Agency policies related to client roles and responsibilities will allow discharge of
this client for services but it is the only support system currently in client’s life. How should
the agency proceed with serving this client?
Barbara Gordon & Molly Dobson
Case Scenario
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Conflict between professional staff and agency on following agency policies during
a disaster situation.
There has been a severe winter storm in a community that has interrupted electrical
services, disrupted travel due to fallen trees and excessive snow, and prevented service
agencies from providing services to vulnerable older adults in the community. The aging
network has an emergency response plan that includes contacting older adult clients in the
community beginning with those who are frail, elderly and living alone. Some agencies
actually go door to door to check on the client lists. Staff is informed of the protocol which
includes deploying seniors to emergency shelters if they do not have electricity and a safe
heating mechanism. Due to the limitation of shelters who will take pets and the seniors
being leery of parting with their pets by sending them to the pound or humane society,
some will not leave their homes. Staff visits a client who has significant chronic health
issues. Her home is below 40 degrees when she arrives. The client is under several
blankets and obviously very cold. She also has a very bad cough and informs the staff that
she is just getting over a bout of bronchitis. Staff tells her that she needs to go to a shelter
until her electricity comes back on. She says that she can’t leave her dog “Charlie”.
Barbara Gordon & Molly Dobson
Case Scenario – Continued
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Staff says that she will try to get her into a shelter that may consider taking her
dog too. She calls around and is not able to find an available spot at the small
shelter that will accept pets. She then offers to take her dog to the pound or
humane society until her power comes back on. The client says I can’t do that
and refuses to leave unless she can keep “Charlie” with her. Staff is at an
impasse because she knows that this client will not budge on this issue but she
is at significant risk of endangering herself if she stays at home. She contacts
APS and is told that they won’t be able to investigate for several days due to
the disaster situation. Staff decides to offer to take the client home with her
(she has heat) until they can remedy the situation with another plan. The client
accepts. When staff returns to her office and informs supervisors of what
occurred she is later reprimanded, placed on suspension and then demoted
because the agency has a strict policy about transporting clients in staff
vehicles as well as taking clients to staff homes. How do professional ethics
weigh in this scenario from the staff’s perspective? How do professional ethics
weigh from the agency’s perspective?
Barbara Gordon & Molly Dobson
Resources
Code of Ethics Websites
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http://www.managementhelp.org/ethics/ethxgde.htm
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http://www.babicm.org/code-of-ethics.php#manager
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http://www.socialworkers.org/practice/standards/sw_case_mgmt.asp
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http://ethics.iit.edu/codes/coe/nat.org.human.services.1996.html
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http://www.greystoneprograms.org/code_of_ethics.htm
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http://www.agacgfm.org
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http://www.entrepreneur.com
Barbara Gordon & Molly Dobson
PowerPoint & Handouts
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The PowerPoint Presentations and other
articles and information can be found at:
www.kipda.org
Presenters Contact Information:
barbara.gordon@ky.gov
molly.dobson@ky.gov
Barbara Gordon & Molly Dobson
CLOSING
THANK YOU FOR PARTICIPATING!
ENJOY THE REST OF THE
CONFERENCE
Barbara Gordon & Molly Dobson