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There are three case scenarios that provide ethical dilemmas for your review for

There are three case scenarios that provide ethical dilemmas for your review for this paper. Select ONE of the three scenarios for your ethical dilemma paper after reading the three scenarios. You will respond to the case questions following the selected scenario in the paper, and will also apply the steps of ethical decision-making from chapter one in the text to the selected scenario.
The paper is to cover the following sections and adhere to APA 7.0 format, including cover page and reference page. The paper should be 5-7 pages of conent, plus title and reference page for a total of 7-9 pages. Be sure to cite information from the textbook both in the form of in-text citations and reference citations. Below are the bolded subheadings for your paper, so be sure to cover each section:
Start with an introductory paragraph that provides a brief overview of the case.
Case Questions
Each case has 5 case questions that follow the scenario. In this second section of your paper, Provide your responses to the five case questions. Please include the number and text of the questions along with your responses. These responses should demonstrate some critical thought on your part.
Scholarly Information
In this section of the paper, locate 2-3 sources of scholarly information about some aspect of this case. Write about what you learn from the scholarly sources in this section of the paper. Be sure to use in-text citations and reference citations.
(The remainder of the paper will come from the steps of ethical decision-making in the text on pages 20-23. Read over each of the sections, and write about the case based on the information posted in the textbook in that section. Be sure to be thorough in your responses and if indicated below, add the additional information indicated).
Step 1: Identify the Problem or Dilemma
(see p. 20-21)
Step 2: Identify the Potential Issues Involved
(see p. 21)
Step 3: Review the Relevant Ethics Codes
(see p. 21 and determine which profession’s ethical code can be referenced in relation to this case)
Step 4: Know the Applicable Laws and Regulations
(see pp. 21-22) In addition to reviewing the material on these pages, for the purpose of your case, review laws that pertain to your own state of residence as well.
Step 5: Obtain Consultation
(see p. 22) In addition to reviewing the material on these pages, for the purpose of this case, talk with another professional in the field and get feedback from that perspective to integrate into your paper.
Step 6: Consider Possible and Probable Courses of Action
(see p. 22)
Step 7: Consider the Possible Consequences of the Various Decisions
(see pp. 22-23)
Step 8: Choose What Appears to Be the Best Course of Action
(see p. 23)
In this section of the paper, write about the biggest challenges for you in discussing this case and choosing your selected course of action. Justify your choice, and discuss how the model of ethical decision-making informed your decision.
Janie is a 25 year old social worker who has been with hospice for about one year. Janie absolutely loves her job. As an agency that takes care of terminally ill patients and their families, hospice provides care in an atmosphere that Janie loves. Janie quickly shows herself to be a leader and is recognized as passionate and excellent in her work. She is selected to train new social workers who come on staff.
You are a 23 year old social worker who just started working with hospice after college graduation. You are new to the field, and as you begin training, you lack some confidence, but you are compassionate and to do the job well.
You and Janie go to visit Edna one day. Edna is a newly admitted hospice patient. Janie has been to the home once before to complete the social work psychosocial assessment. Edna was battling terminal liver cancer, and though her prognosis is not very good, she is still able to live alone and able to do basic self-care and meal preparation. Though she doesn’t feel well many days, she is determined to fight to live. On the day of this visit, she is alert and oriented to person, place, time, and situation. This means she knows who she is, where she is, when it is (time of day, day of week and year), and understands the details of her health situation.
As a new social worker in training, you have been observing for the past couple of weeks and it is your turn to “lead” the visit with Janie’s supervision. Edna had mentioned during her hospice admission that she does not have an advance directive, but she is interested in learning more about how to do one. You have been trained about educating patients about advanced directive options. Advance directives are legal documents that allow patients to make choices about their end-of-life care prior to the time when they become too sick to make the choices on their own.
During this particular visit, you ask Edna if she is interested in completing an advance directive. She states, “I don’t want to be kept alive on any machines.” You proceed to educate her about end-of-life health care options, such as artificial ventilation, IV hydration, feeding tube nutrition, etc. Immediately and aggressively, Edna stated, “I don’t ever want a feeding tube! I watched my mother die on one of those things, and it was awful. I don’t ever want my kids to have to see that.” You proceed to educate her about the living will document that would allow her to make the choices regarding her end-of-life care.
As a social worker with hospice, you are trained to help people complete their advance directives. After you successfully educate Edna about all of her options, she states that she wants to go ahead and complete her living will. You complete the form with Edna in Janie’s presence, where Edna states that she does not want any type of artificial ventilation, hydration, or nutrition. She does not designate a health care surrogate to make decisions for her when she becomes unable to do so. She simply directs what she does and does not want in this document. Janie notarizes the form and documents the visit, indicating in her documentation that Edna was alert and oriented. You both make sure Edna’s living will is on her hospice chart, on file at the local hospital, and a copy is sent to all of her doctors.
Nearing the End
Edna lives almost a year longer before she moves into a steady health decline. As she nears the end, family from out of state come in and alternate turns caring for Edna. As is normal with typical active dying process, Edna eventually becomes unable to walk, communicate, control her bowels and bladder, and unable to swallow. She can still make eye contact and follow someone’s gaze, but is otherwise not communicating. This means Edna is unable to consume any food or water by mouth. This is something her children cannot bear to watch. They believe they are watching her “starve to death.” They take her to the local hospital with plans of having a feeding tube inserted to provide Edna artificial nutrition. As surgery time nears, the hospital finds in her records a notarized document, signed by Edna, requesting that no artificial nutrition be provided if she were no longer able to make decisions for herself. The surgeon refuses to complete the procedure against the patient’s wishes. The family is furious. They said that their mother would have never completed a document like that of her own free will, and if she did do it, she was either pressured to do so, or was not in her right frame of mind. Still, the surgeon refuses to do the procedure. The family takes the case before a local family court judge to have the living will overturned. They argue that Edna was not in her right mind and she would have never made a decision like that. The judge made the decision to overturn the legal document and allows the feeding tube to be inserted.
You are called into the office to discuss the situation with Edna. The documentation of the visit had been reviewed, and you are being questioned about the circumstances of the visit. You explain the visit to the best of your recollection, since it was a year prior, and the documentation reflects the fact that Edna was in the right frame of mind when she made her decision. Because the documentation was in order, you are cleared from any wrongdoing by the agency. You will continue to work with Edna and her family, despite the discomforts surrounding the issue.
Case questions:
What primary issues does this case raise for you? Who are the people in the scenario facing ethical challenges?
Consider the initial visit with Edna. Was there anything you might have done differently on that day, or in the visits shortly thereafter that might have changed the outcome of the situation?
What could have possibly improved the situation with Edna’s family?
As Edna approaches end of life, she is no longer able to communicate effectively. Whose wishes should take precedent at this point, and why?
Do you feel that you or the agency has further ethical and/or legal obligations in this matter after the tube is placed?
You are a case manager working with children through a local community mental health agency and have gone to the school to visit with Sarah, age 12. Sarah is a patient that you have been working with for approximately one year. Sarah has a diagnosis of Oppositional Defiant Disorder (ODD) and has been receiving services due to her display of aggressive behaviors both towards her peers at school as well as school staff.
Sarah was placed in foster care at age 11 following a physical altercation between the patient and her mother. Though Sarah has a temper and is a difficult child to manage at times in terms of behaviors, social services found that Sarah had been physically abused, and she was placed in foster care until her mother could complete her case plan to regain custody. Following parenting classes, anger management, and some outpatient drug abuse treatment, Sarah’s mother was able to regain custody.
During your visit today, Sarah seems distracted and is not engaging in conversation as easily as she normally would. You continued to talk with Sarah and note of the fact that she is wearing a turtleneck sweater in late spring. You mention the sweater to Sarah, and she avoids eye contact and doesn’t answer the question. Sarah then flippantly says that she and her mother “got into it” last night and her mother pushed her down, put her hands around her neck and held her to the bed. Sarah denies any wrongdoing on her part, though in your experience in working with Sarah, you find her to be dishonest at times. She tells you that it was hard to breathe and that there are bruises on her neck, so she wanted to make sure that they were covered up today. She was unwilling to show them to you.
Sarah just returned back home to her mother from foster care. She begs and asks you not to tell anyone because she does not want to go back into foster care. Sarah says you are the only person that she has told because she trusts you, and you have been there for her in the past.
When you returned to your agency, you reviewed the case with your supervisor. Your supervisor indicates that Sarah is a troubled child from a troubled home, but that she knows her mother personally and knows how hard Sarah’s mother worked to regain custody of her child from foster care. She indicates that Sarah lies frequently. You are well-aware of this, as you have seen Sarah engage in attention seeking behaviors and lies when they benefit her. You also know how ODD works, and have witnessed Sarah become aggressive and defiant towards her mother and you recognize that she is difficult to manage. Your supervisor tells you that you didn’t see anything on her neck, and she was probably lying about it anyway, and she tells you that we need to keep Sarah on your caseload due to a recent drop in our program’s numbers. She indicates that you are not to report the suspected abuse to social services.
Case Questions
What are the primary issues that are raised for you by the scenario?
How does Sarah’s diagnosis of ODD impact your feelings about the scenario?
What are your impressions about Sarah’s mother in this case?
How do you feel about the supervisor’s directive to you?
Do you have any ongoing ethical obligation despite what the supervisor has indicated?

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