As social workers, we care about people hence why we chose this profession. We want them to live the best life they possibly can. And as social workers- we are sure we know what the best choices are to get what we view as the best life.
In most cases it turns out though that even though we are helping individuals like Mary in finding her way. But their choices and desired outcomes aren’t up to us. One of the main tenets of social work is self- determination.
It is imperative that a social worker is aware of their own values and beliefs so they don’t subconsciously moving the client to the clinicians goals. Now, of course we want to act for your clients best interest but who decides what that is?
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In this case, a social worker is working with a client who is pregnant and struggling with substance abuse. Although the client, Mary has been completely noncompliant with her program, and has received warning letters, she cannot be terminated because of a county health regulation that stipulates pregnant women are health hazards and cannot be released into the general population. Mary was sentenced to six months incarceration for theft, but the sentence was suspended with the stipulation that she comply with a substance abuse treatment program.
But because she is placed in the substance abuse treatment program means she once before took part in substance abuse. Dual diagnosis between drug abuse and mental illness are very common. More and more people are suffering from a combination of substance abuse and mental health related issues. While alcohol and drug abuse can make symptoms of mental health problems worse. Because of this, clients have to go to treatment facility or mental health treatment and different facilities for substance abuse treatment.
This kind of treatments can sometimes not always be successful for everyone because this leaves the client trying to cope and or manage a disorder on their own. For these particular individuals/ clients it’s almost impossible for them to manage the other disorder because if they could quit on their own they wouldn’t be in the position or treatment they are in. So as a result, I do believe that substance abuse is evidence of mental incompetence, which would then be used to justify the suspension of self-determination and freedom in favor of the imposition of “best interest” from another person, society or yourself.
Mental illnesses are mental conditions that disrupt the way a person thinks, feels, frequent mood swings, and the ability to relate to others and daily functions. These types of clients are never in the right mindset to make the best choices for themselves. Instead they are wondering how they will be able to get their next dose of drugs which takes away from one’s self- determination and imposition of “ best interest”. Like stated in standard 1.02, if one can’t be in the proper state of mind to make reasonable choices you shouldn’t and a social worker may limit clients right to self determination if they feel the client’s actions or potential actions pose a serious risk to themselves or others.
In this case, Mary is a young woman who is pregnant. Mary refuses to get prenatal care until she is six months pregnant. She states that she is afraid the doctor will make her feel guilty for endangering her baby with her substance abuse. While fetuses can be harmed by means other than substance abuse, such as poor nutrition, inadequate medical care, reckless driving, smoking, refusal of routine prenatal vitamins, fatigue, excessive exercise, overwork, and so on. It is important that pregnant women should be monitored for the prevention of all possible harm to the unborn. When you are pregnant you want to be sure you start prenatal vitamins right away to ensure you and your baby are getting the proper vitamins and nutrients needed.
Aside from that you want to go to your doctor for every appointment and be sure to never miss one. Going to your doctor throughout your pregnancy will help to keep you and your baby safe your doctor will know what’s best for you in forms of nutrition, what to do if you smoke or have participated in substance abuse. They will never shame you just help you to ensure you and your baby are in the best hands and stay healthy. I, basing my answers off of standard 1.03 letter d. Meaning that even though Mary still has her rights to refuse going to receive prenatal care. With receiving services involuntary it’s important we as social workers explain and provide information about what the purpose of prenatal care is about and why it’s important.
With Mary being pregnant and refusing to get prenatal care until she is six months pregnant that can potentially cause harm to the fetus. The legal status of fetuses in this country is, at times, unclear, often leaving the social worker with little guidance. This tends to foster decision making based on personal values when the well-being of a fetus is at risk. I feel as a social worker you are professionally justified in intervening to protect the well-being of the fetus.
When you have a client who is pregnant and in this case refusing to get prenatal care for her and her baby that is potentially putting the fetus at risk. Though, the fetus isn’t your client you still want to make sure your client isn’t putting themselves or others at risk. This based off standard 1.02 by the fact that Mary is refusing prenatal care till later in her pregnancy that can potentially put her and the fetus at risk.
Of course as a social worker, self- determination is a value you have a huge affinity for. We don’t want to get carried away with what we think will be best for the client, but what the client is saying and actually wants. You want to value and do your best to reach the goals of your client and their individual choice, but some instances call for us to set limits on their self- determination.
