Self-determination is at the core of the social work profession. Self-determination can be defined as the clients’ right to make their own decisions about their lives and their treatment. We may not always agree with our clients’ choices, but honoring their self-determination means we support them in the decisions they make (even when we ourselves would not make the same decisions).
Questions on self-determination WILL show up on your ASWB social work exams, whether you are studying for the master’s level LMSW exam or the clinical LCSW exam. In many cases, the exam is looking for us to support our client’s self-determination. There are instances, however, in which the safety of our client (or the public’s safety) trump this ethical principle.
When Are We Unable to Honor Client Self-determination?
- A client is actively suicidal
- A client is homicidal
- Your client lacks decision making capacity and someone else has medical power of attorney for them
- Your client is abusing or neglecting a child, elderly person, or dependent adult
Do you know when to honor a client’s self-determination and when to address potential safety concerns that are present in any given situation? See how you do on this week’s FREE practice question:
Self-Determination Practice Question:
An 80-year-old client meets with a social worker due to recent conflict with his adult children who are urging him to move into an assisted living facility after his wife of 60 years passed and after he began using a cane. His children express ongoing concern that as he ages, he will be unable to care for himself and meet his basic needs while living alone. The client reports that he is just as able to care for his needs now as ever before and states, “there is no way anyone is going to force me into a nursing home.” What is the BEST way for the social worker to respond?
A. Facilitate a discussion of the pros and cons of living in an assisted living facility and offer a family session
B. Discuss the differences between a nursing home and assisted living facility
C. Validate the concerns of the client’s children and complete an assessment to determine client’s ability to live independently
D. Acknowledge the client’s right to make this decision for himself and identify goals of treatment
(scroll down for answer and rationale)
The correct answer is D
- Since the question is asking what is BEST, we want to prioritize around importance. A is incorrect because the client stated he does not want to move into a facility. Since there are no details in the question stem that indicate a need for the client to move into an assisted living facility, we want to honor his self-determination. Additionally, the man is our client, not his children. So we want to first help him identify the treatment goals he wants to work on before offering a family session.
- B is incorrect because again, the client has already stated he doesn’t want to live in a facility. So this is not a discussion that would need to take place at this time.
- C is incorrect because the client is in the room with us, not his children. Further, there is no information that indicates the children’s concerns are valid. There is also no reason to complete an assessment to determine his ability to live independently at this time.
- D is the best answer because it both honors the client’s right to self-determination AND acknowledges that he is the client.
How did this question go for you? Did the correct answer and rationale align with your understanding of client self-determination?
If you have any lingering questions about this topic, we encourage you to contact one of our social work coaches who are here to answer any questions you have.
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