Ethical dilemmas in general hospitals: differential perceptions of direct practitioners and directors of social...

Two distinct groups of social workers in general hospitals, fourteen directors of social work services and eighteen direct practitioners, were interviewed concerning their perception, ranking and resolution patterns of ethical dilemmas. The reverse order of importance and somewhat different content of ethical dilemmas identified by the two groups reflect their differential position in the hierarchy of hospitals and the difference in their experience in dealing with ethical dilemmas vis-à-vis clients. The directors tended to depend more on internal loci of authority, and were far more concerned with how to interpret and apply the relevant laws than the direct practitioners. Their decision making patterns seemed to be more virtues focused in contrast to the utilitarian and rights based focus of the direct practitioners. The findings emphasize the need for social workers' knowledge of ethical theories, rules and principles, and ethical self-knowledge. They also point out the need for written protocols of debates and/or detailed descriptions of applications of ethical decision making models to case situations in practice. The latter may provide guidelines for social workers in similar situations in the future, and at the same time be used as material for teaching and supervision.