The Need for Practice Guidelines for Social Workers Facing Ethical Dilemmas
in End-of-Life Care
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Csikai Ellen
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School of Social Work
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Stephen F. Austin State University
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Box 6104
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Nacogdoches TX 75962
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936-468-4020
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FAX: 936-468-7201
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ecsikai@sfasu.edu
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Roth Sheila
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Dept. of Social Work - Antonian Hall, 501-D
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Carlow College
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3333 Fifth Avenue
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Pittsburgh PA 15213
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412-578-6025
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FAX: 412-578-6357
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sheilaroth1@hotmail.com
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Moore Crystal
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School of Social Work and Human Services
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Eastern Washington University
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526 Fifth Street, MS 19
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Cheney WA 99004
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509-359-6425
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FAX: 509-359-6475
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crystal.moore@mail.ewu.edu
Purpose: End-of-life issues are becoming increasingly important
to examine due to the inherent ethical dilemmas that require social work
attention. The purpose of this study was to examine the ethical dilemmas
in end-of-life care that social workers encounter in their daily work,
how they respond, and the possible need for practice guidelines in order
to be able to effectively manage these situations.
Methods: Qualitative interviews were conducted with 12
hospital social workers at a large urban cancer center. A semi-structured
interview guide explored participants' experiences with various types of
ethical dilemmas in end-of-life care (typical and complex), methods of
resolution, educational preparation for end-of-life care, and perceptions
of the need for practice guidelines. The data were analyzed using a form
of template analysis involving the creation of a priori coding categories
based upon the main research questions. (Crabtree, & Miller, 1992;
Miles & Huberman, 1994). Quotations associated with these coding categories
were analyzed for themes and subjected to interpretive analysis. This sample
was part a larger study of hospital social workers' experiences in end-of-life
care.
Results: Findings revealed that these social workers do face
some common ethical dilemmas in assisting patients and families with decision
making regarding end-of-life care. Common themes that emerged from the
participants' responses for dilemma types were: when to stop treatment,
hospice care, conflicts among family members, and conflicts among team
members. Methods of resolution of these dilemmas most common were categorized
as: discussion/clarification of information and referral to ethics committee/consultant.
A range of end-of-life care education and professional experiences existed
among the participants.
Implications for Social Work Practice: These social workers
who encountered end-of-life care situations frequently, provided some in-depth
insight regarding ethical dilemmas involved and difficulties of resolution.
All participants agreed that construction of practice guidelines for social
workers dealing with end-of-life care situations would be worthwhile.