decision-making capacity and the social work examAs we near the end of the first part of the NASW Code of Ethics, we arrive at 1.14, Clients Who Lack Decision-Making Capacity. It's a short, single-sentence section:

When social workers act on behalf of clients who lack the capacity to make informed decisions, social workers should take reasonable steps to safeguard the interests and rights of those clients.

What reasonable steps? Look back to 1.03, Informed Consent for some guidance:

In instances when clients lack the capacity to provide informed consent, social workers should protect clients' interests by seeking permission from an appropriate third party, informing clients consistent with the clients' level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients' wishes and interests. Social workers should take reasonable steps to enhance such clients' ability to give informed consent.

Here's a decision-making capacity question:

A social worker in a residential rehab meets with a client who plans to discharge to drug study which will test a new anti-psychotic drug. The client has no history of psychosis. He explains, "It's three hots and a cot and I get paid." How should the social worker proceed?

A) Contact administrators of the drug study regarding potential ethical violations.

B) Explore the possible consequences of the drug study with the client.

C) Take steps to have the client conserved due to impaired judgment.

D) Find a better placement for the client by discussing the drug study plan with the client's family members.

How did you answer?

If you've worked in a rehab setting, you may have encountered this very situation. There are problems with each answer. Discussing the plan with family members breaches client confidentiality. Scratch D. How about C? Well, the client does not appear to meet criteria for being conserved. (It's a decision-making capacity question, but the client in the vignette doesn't appear to lack decision-making capacity.) Taking steps toward conservatorship ignores the client's right to self-determination. So too does contacting the administrators of the drug study (which ignores both client self-determination and confidentiality). That leaves B, exploring the possible consequences--the pros and cons--of the client's plans. It's the best answer. The social worker--and the test-taker--may want to do more, to prevent the client from making a potentially harmful move. But clients get to make their own decisions, in life and on the test.

For more questions about the NASW Code of Ethics and much more, sign up for SWTP practice tests.

December 7, 2015
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