CASE STUDY 1 – NORNI AND JIM

Norni and Jim talked frankly about ageing and death long before either of them reached old age. They both agreed that
they did not want to be kept alive artificially and that they would like to refuse treatment when they no longer had a good
quality of life.
When Jim entered residential aged care he specified his wish which was recorded on his file. His wife had a medical
power of attorney for him so that she could make decisions about his treatment if he was not able.
After a period of time his health worsened. He no longer knew his wife and suffered pain and discomfort. He suffered
many chest infections.
After one particularly bad chest infection Norni spoke to Jim’s doctor and said that she no longer wanted his chest infections
to be treated with antibiotics. The doctor knew Jim’s wishes and agreed that this was what he would have wanted. His next
chest infection was his last. He died peacefully and with dignity.
One of the personal care workers was heard to say in the staff room, ‘I can’t believe the doctor didn’t give Jim antibiotics.
He would have been alive now if he had. That’s malpractice! His wife probably just wanted his money quicker.’

1. How has the personal care worker breached ethical requirements?

2. What would have been the ramifications if Jim had been given antibiotics against the instructions
of his wife? 3. How did the personal care worker’s values differ from those of Norni, Jim and the
doctor?
4. What action should be taken by the person who heard the personal care worker’s comments?

Norni and Jim - The End-of-Life Care

Introduction to Case Study 1

In today’s time, choosing death over treatment on dying patients is still debatable. Some would argue
that it as an end-to-suffering and ethical in terms of respecting the patient’s right, whilst others strongly consider
it as immoral and extreme heartlessness. In the medical field, it is vital that a patient must have an enduring
power of attorney provided that the appointee is capable of making medical decisions for the patient. Overall,
this case study shows the consequences if
How has the personal care worker breached ethical requirements?

In this case study, the personal care worker clearly disregards the ethical requirement through
disrespecting the client’s choice, and for disrespecting a colleague by literally voicing out her perspective towards
Refusal to Medical Treatment Rights or the Patient’s Rights. The couple have already decided to not get treatment
to extend life even before Jim set foot in the residential aged care. As part of our duties and responsibilities in
community services, we must always abide by the Code of Ethics in terms of respecting the choices of our clients.
My takeaway on this would be, I may be entitled to freedom of expression, however our opinion is not
accepted if it is opposed to the standards of practice in the medical field.

What would have been the ramifications if Jim had been given antibiotics against the instructions of his wife?

Since Norni has a medical power of attorney, this gives her the legal right to decide on behalf of her
husband’s medical decision making. With that being said, if Jim was given medical treatment in opposition to the
request of Norni, this may result in a legal action, like gross negligence and/or criminal offense due to
unauthorized medical procedure.

How did the personal care worker’s values differ from those of Norni, Jim and the doctor?

While I understand the point of view of the personal care worker about ‘right to live’, and morality, it is
also not right to practice freedom of speech in a workplace wherein he/she belongs. Just like her, Norni, and Jim
just want to express their right to respect, while the doctor was only adhering to the legal and ethical
requirements. In this case study, the personal care worker shows lack of sympathy and self-awareness.

What action should be taken by the person who heard the personal care worker’s comments?

The doctor or whoever heard/saw the personal care worker made remarks, he/she must file a complaint
to the management. In that way, an appropriate action will be in place. Maybe, a refresher training would help to
remind him/her to abide by the standards of practice and will be assessed on what other help she/he may need
to prevent the issue from happening again.

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To conclude, apart from considering diversity in the workplace, I must always be heedful on how I
express personal biases in regard to medical standards of practice, and also I should not forget about the
patient’s right to respect.
Norni is very sad after her husband’s death. She confides in you that she misses him terribly. She is glad that
he is finally at peace but is also struggling with her decision to refuse treatment. She knows that is what Jim
wanted but wishes he was still with her. She tells you that she can’t sleep at night and does not feel like eating
at all. She thanks you for the care that you provided to Jim in his last weeks of life.

5. What would you say to comfort Norni?

 It cannot be denied that Norni is showing minor anxiety and depression. These types of emotions are normal
especially if we lose important people in our lives. However, if it’s not assessed properly by an expert, it can lead to
serious mental illness.
In this case, I would comfort Norni in a way that would make her feel she is not alone and that what she did was
just doing what Jim wanted to happen from the very beginning. I would also tell her that I am very glad she opened up
how she felt as that is the right thing to do and that she doesn't need to rush things. Everything won’t be the same
without Jim but she must move forward as for sure, that is what her husband wanted her to do.
In addition, research has found that communication has to be the centre between aged care workers or any
healthcare worker and patient relationship, even the family of the patient. Having a good foundation of communication
with the clients and their family effectively builds trust and comfort, especially to the family who loses their loved ones.

Norni is so thankful to you for all the support you have given to Jim and her that she presents you with Jim’s
gold watch and says she wants you to have it. It is old and looks very valuable.

6. Would it be a conflict of interest to accept this gift? Explain your answer.

It is definitely a conflict of interest to receive gifts from clients. In most instances, this action would
extremely affect the patient-carer relationship. In the industry of health and community services, it is typical for
patients and their families to give gifts to their healthcare or carer as this is their way of showing gratitude and
satisfaction from the service they received. In contrast to that, most if not all patients and/or their family are
giving presents thinking that it would give them the advantage of getting more attention from the healthcare
worker.
At my workplace, there’ll be instances that we are outnumbered by clients coming in. We cannot avoid
such situations as we do really need additional carers. There were a few times clients would try to give gifts but
I would always politely reject them. Aside from it is unethical to accept the gifts and for sure would create
conflict of interest with my coworkers and other clients, I know that I will suffer in the end because clients would
definitely assume that both of us have some kind of mutual understanding that I need to take care of them more
than others.

7. What would you say to Norni in regards to the gift she has offered?

In the situation of Norni, It is pretty much expected that she’ll give a gift to express appreciation
and satisfaction but that should not be an excuse to accept gifts. I would politely decline the gift from
Norni, and would make her understand that aside from doing my job, it is also natural for me to take
care of my patients. I treat everyone equally and like a family. I would then encourage her to rate our
organisation by answering a Client-feedback form.
Therefore, it is always important to set boundaries not only with coworkers, but most of all with
the clients. These boundaries would encourage a more healthy client-carer/health worker relationship.
What do I need to hand in for this case study? Have I completed this?

Your answers to each question

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 CASE STUDY 2 – MAYA

Maya is an Aboriginal lady from the Kimberley region. She lives in a small, remote community but has
recently entered an aged care facility as she is seriously ill with cancer. She is not expected to live more than
a few months. The closest aged care facility that could take her was four hour’s drive from her home. The
facility has only one male Aboriginal worker, Benny. The rest of the personal care workers are all female
non-Aboriginal people. Most of the residents at the facility are not Aboriginal.
Maya does not settle well into the facility. She does not eat the food unless it has been brought to her from her
family. She likes to chat with Benny and tells him that he is the only one who understands how she feels about
being so far away from home. She will not let Benny assist her with tasks such as dressing and bathing,
however, as he is male. She often refuses to shower.
Other residents have complained that Maya is rude and often ignores them, and never looks them in the
face. They also say she is dirty and they do not want to associate with her.

1.What issues does Maya face regarding communication with staff?

2.What issues does Maya face in communication with other residents?
3.What assistance can Benny give to other staff to assist them to communicate with Maya?
4.Is Maya being rude when she doesn’t look people in the face when talking to them? Explain your answer.

Maya - The Aborignal Australians in Community services

Introduction - Case Study 2
In this time and age, Aboriginal People still experience racism even though the government has been
trying to intervene and stop discrimination among the indigenuos peoples cutlure. The government of
Australia has implemented the Indigenous Peoples Rights Act 1997. This Act is to ensure that Aboriginal
Peoples are protected, recognized, and promoted the rights of the indigenious people of Australia. In the
past, they experienced extreme racism from the Europeans during the colonization era because of their skin
color and lack of civilization. Therefore, most if not all, Aboriginal people in the present are still not
comfortable around the non-aboriginals.

What issues does Maya face regarding communication with staff?

In this case scenario, Maya’s action towards the people in the facility is understandable in a way that
she must be feeling anxious and worried to experience discrimination at any moment. She might have
possibly experienced a traumatizing treatment when she was in her previous Care Facility. At the same time,
since she has found a person, Benny, who is in the same ethnicity, that’s when she finds courage to talk.

What issues does Maya face in communication with other residents?

Although the some Aboroginal People are now more civilized, it cannot be denied that when talking
around non-aboriginal make feel intimidated or sometimes they think that everyone is trying to criticise them.
Most possible causes of Maya’s issues in communication are feeling inferior towards the non-aboriginal and
maybe seeking for belongingness.

What assistance can Benny give to other staff to assist them to communicate with Maya?

We are all aware that communication is fundamental to building good relationships. In this case, it is
best that Benny would share a little bit of information on how to handle indigenous women in order for them to
effectively speak to Maya. Benny may advise them to try to be “overdoing”. For example, when they approach
Maya, they should approach her just like how they do it with anybody else in the facility. Make sure to speak
and use a tone that isn’t so formal, not too informal. If they can see an opportunity to speak to Maya, they
need to tell her that she’s in good hands. They must express empathy like, they understand she may be
anxious or feeling alone, and then assure Maya that everyone working in the facility is professional and is well
trained and can guarantee her safety while she stays. Finally, they may consider using hand gestures
whenever they have to explain something to Maya.

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Is Maya being rude when she doesn’t look people in the face when talking to them? Explain your
answer.

No. The action of Maya may be an indication that she is not comfortable with the person she’s talking to.
Some would definitely find it rude when a person doesn't look back while you are talking. This is a characteristic of an
Aboriginal person who may feel anxious in speaking especially with a non-aboriginal.
Benny explains the process that will happen when Maya is near death. Various members of her family will
gather to be with her. On her death they will conduct a smoking ceremony to purify the room and remove bad
spirits. The body will then be taken back to her homeland to be buried.
The health and safety officer says that he understands this is Maya’s custom, but the smoking ceremony
cannot be undertaken in her room. This would set off the smoke detectors and other residents may complain
about the smoke. He suggests they do the smoking ceremony when her body is back at home.
Benny rolls his eyes and walks out of the room in disgust.

1. What are Maya’s rights to the smoking ceremony?

2. List two things that Benny can do to support Maya to ensure that her rights are met.
3. List three things that Benny and the health and safety officer should do to resolve their differences.

What are Maya’s rights to the smoking ceremony?

As part of Human Rights, each ethnicity has the right to ratify their privilege on the part of identity groups
particularly on religion, language, and culture practice. Because of this, Maria can definitely express her
rights to hold a smoking ceremony, provided that it is also aligned with the Region's Charter Rights.

Two things that Benny can do to support Maya to ensure that her rights are met.

First, Benny must understand the Human Rights legislation in their Region. Just like in Victoria, they have
this Charter of Human Rights and Responsibilities Act 2006, wherein it covers the Aboriginal Protocols
and the rights of First People of Australia. Second, Benny may help in finding the best location where they
can hold the Smoking Ceremony. His workplace was right when they said that they need to consider the
facility when there’s smoke.

List three things that Benny and the health and safety officer should do to resolve their
differences.

Since Smoking ceremony involves fire, it is right that the workers would consider the safety of many,
especially the clients inside the facility. To address the concern of Benny about culture differences and
practices, the following must be considered:
1. Instead of saying a flat “No” on Benny’s request on behalf of Maya, the team should brainstorm and
decide carefully the matter to avoid misunderstanding. The Aboriginal Peoples would always take it as
 disrespect and racism if their culture is recognised.
2. The organisation must help Maya to find a location to conduct her Smoking Ceremony. They may do it
outside their building.
3. Lastly, both parties must discuss both issues professionally. The organisation may want to consider being
more open to the Aboriginal Culture since the Smoking Ceremony is already being acknowledged in most
Regions of Australia.

What do I need to hand in for this case study? Have I completed this?

Your answers to each question

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CASE STUDY 3 – MARIA AND MARCUS

Maria and Marcus work with people with disabilities in respite care. Recently Maria asked her friend and work
colleague, Marcus, what is the matter. He has been very pre-occupied lately and it is starting to show in his
work. He is short with the clients and really lost his cool when two of the clients were arguing at lunch time.
Maria has also noticed that he seems to be distancing himself from the clients sometimes. Yesterday Keith was
getting very frustrated when he couldn’t do up his buttons – normally Marcus is very good with Keith and takes
time to talk to him and reduce his frustration levels but yesterday Marcus just walked out of the room and told
Keith to get Maria to help him.
Marcus decides to confide in Maria but makes her promise not to tell anyone what has happened. He has been
charged with assault following a pub brawl which resulted in the person being seriously injured. He has spoken
to a lawyer who has advised that it will definitely go to court but it will be some time before his case is heard –
probably more than 12 months. He insists it wasn’t his fault – the other guy was being an absolute idiot in the
pub and pushed Marcus until he lost his temper and hit him.
Marcus is worried sick about what will happen when he has to go to court. But he is also worried about his job
now. He knows he should declare the charges to his supervisor but he is sure that he will not be allowed to
continue at work due to the seriousness of the charges. He needs the job so he will be able to show in court
that his is gainfully employed, and also so he can pay for his legal costs.
Maria gives him a hug and feels very bad for Marcus. Marcus tells her that he is taking a week’s leave to sort
things out and that Maria must keep it a secret. Maria knows she should not do that. It all seems very unfair
and now she has a problem too.

Advise what you would do in Maria’s position.

Dealing with Unethical Coworker

Abiding by the legal and ethical policies is a basic act to do inside the workplace. Even outside working
hours, employees must still be mindful of their actions; otherwise, it’ll comprise the reputation of their
workplace. It can be very distressing if we keep something that is unethical but I would obviously make a
difference once you have the courage to report the wrong doings of an individual.

In this case, Maria, who has a coworker, got in trouble outside work. Not just an ordinary trouble but a
lawsuit. If I were to give advice to Maria, I would encourage her to talk to Marcus again and tell him to
 inform the management. If Marcus still insists on keeping it a secret, then she must decide as soon as
possible whether to report it or not.

I would also remind Maria how Marcus was obviously in distress in the past and was extremely affecting
his job. Tolerating such behaviour will not help Marcus from learning in this situation. It’s better that the
management are aware so they can also advise Marcus with decision-making..

What do I need to hand in for this case study? Have I completed this?

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Your answers to each question

James is a member of the local hospital board. His father is getting old and frail and has had some medical
problems lately. The family is looking for a prioritised place in the local aged care facility. As a member of
the board, James will have some say in whether his father is offered a prioritised place or not.

CASE STUDY 4 – JAMES

1. What is the problem in this case study?

The main issue is his father needs a centered-paperson care provider. It is not because he is a member of
board executives, it is about the well-being of his dear father.

2. What should be done?

James must look for a homecare/aged care service that is a centered-person care. This type of home
care focused on achieving the client’s together with his family, rather than prioritizing the
organisation's goals.
In this situation, nothing is done and James influences the board to approve the priority place for his father.
He justifies his action by saying that his father was a clear priority and that the decision would have been the
same whether he was on the board or not.

3. If this is the case, has James and the rest of the board made an ethical decision? Why/why not?

I would definitely not agree. In the field of health and community services, it is not ethical that the
Practitioners prioritise their loved ones or would do medical treatment to a direct family. James must be
professional and should also think of other patients who come in first before his father.

4. What should the rest of the board have done?

It would have been better if everyone came up with a better plan. I understand James cares a lot about
his father but they must act responsibly in a way that it would be an ethical decision. They may suggest
that since James wants his father to be prioritized, he may consider bringing his dad to a homecare that
 is person-centered.
What do I need to hand in for this case study? Have I completed this?

Your answers to each question

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CASE STUDY 5 – HERRIOT

You are working in a community health service which is run in conjunction with a youth ‘drop-in’ program. known as
Youth in Front. Herriot Malini is a 14-year-old girl who has been attending the program for some time. Herriot has a mild
intellectual disability with sub-average intellectual functioning and lack of social skills. Herriot has a reputation for
dishonesty including telling lies and stealing from others.
You have noticed lately that she has been withdrawn and subject to fits of temper. When you ask her if she is okay, she tells
you that no, she is not okay and how would you feel if your mother’s boyfriend kept feeling you up?
As you talk to Herriot, she discloses that her mother’s boyfriend has touched her sexually on several occasions when her
mother has been at work. She has now moved in with her grandmother to get away from him. Her mother went crazy when
she found out she was living with Grandma and when she told her why she called her a ‘lying little b***h’.
She tells you that she wants the man locked up so he can’t hurt her anymore but she also tells you that she would be much
too scared to talk to authorities about what has happened.
Herriot also says that her mother has no rights over her because she is not her real mother but only a guardian because
her mother died when she was a baby.

1. What legislation covers the protection of children against abuse in your state?
● The Child Abuse Act in the Philippines is the Republic Act 7610: Special Protection of Children Against
Abuse, Exploitation, and Discrimination Act.

2. Herriot has a reputation for lying. Does this mean you should decide whether or not she is telling the truth before
reporting the allegation? How may the code of ethics assist you with this decision?
● It is stated in the Mandatory Reporting policy that any reports handed over will still be carefully investigated.
What’s unethical is that, letting a child into possibility of being sexual harrasment and neglect.

3. Where can you find information about how to deal with allegations of client abuse inside and outside of your
organisation?
● If it’s inside the organisation, you may find it through the information desk or from a direct supervisor. While
you can find it outside by asking directly the in charge authorities.

4. What guidance does a code of ethics give in relation to confidentiality in this case?
● It’s about not only making sure to secure personal information of the client, but also the confidentiality
rights of the professional who made the report. Also, Child Abuse and Neglect is one of most
delicate

5. Is Herriot right when she says her mother has no rights because she is not her real mother?
● Regardless if she was not Herriot’s mother by blood, but was legally registered as her mother, the lady will
have rights over Herriot until she reached legal age.

6. You realise you will need to report this to your supervisor. When should you do this and what would
you do if your supervisor was not available?
● If the supervisor is not around, it is my responsibility to make decision on when and how I am going to
report a suspected child abuse or neglect. Although it is best to talk it out first to some higher or a
colleague, as this could be a way for me to know if the case has been filed already or not. I may need to
consult another professional or call the authority directly.

7. What communication and interpersonal techniques would you use when talking with Herriot?
 ● It would be best to talk calmly with Herriot as she has a tendency to a sudden short period of uncontrolled
anger. At the same time, I must also give her an impression that I am not intimidated or scared at all and
that I must make sure that I made him feel important.

8. You may have personal values that conflict with those of Herriot’s family. How would you deal with this?
● As a professional, it is basic not to intervene in any personal issues of clients and family. I must solely
focus on the child's well-being.