Illuminating the Complexities of Ethical Decision Making

Hospital-based professionals who manage cases of family violence are often unclear about the benefits and costs of particular interventions to their clients. Operating under conditions of potential lethality, both to them and family members, clinicians often experience conflict between legal and ethical recommendations or between strategies intended to provide safety to victims of domestic (spousal) violence and those meant to protect children from abuse. This article presents a situation of family violence and the dilemmas of decision-making confronting both social worker and lawyer. It discusses such issues as professional role, reporting requirements, and duties to warn, emphasizing the difficulty of implementing a plan and of predicting its consequences. It recommends substantive and procedural guidelines that may help protect victims while allowing professionals to emotionally sustain themselves during the management ordeal.