The principles of the Code address a sometimes problematic term – reasonable. How can case managers assure that their actions are considered reasonable when attempting to avoid ethical dilemmas or conflicts? How can others who examine whether a case manager engaged in ethical behavior relevant to a specific situation come to a conclusion that indeed the case manager “…has considered all the reasonably available options”?
- What are reasonably available options for your clients/support systems?
- How are you to decide on what is reasonable?
- How can you be certain that the services provided or decisions made are reasonable?
Clearly, there must be constraints to what is “reasonable.” The very word implies limits. Case managers do not owe their clients “the sun, the moon, and the stars,” but sometimes deciding precisely what clients are “reasonably” owed can be extremely challenging.
While you cannot make medical decisions, you nevertheless can often take some steps that affect your clients’ care in ways that directly affect the scope or nature of their benefits.
How are you supposed, then, to proceed ethically in the care you provide your clients/support systems? One important answer is to look to the law.
Ethics and the law are popularly represented as opposites, but that representation is untrue.
Going back to Aristotle, you might understand the law as minimalist ethics – the moral beliefs and practices that a society will absolutely insist on and enforce through its policing powers. For example, the Code’s rules of conduct assert that board-certified case managers “cannot falsify an application or documents… [or be] … convicted of a felony” (2015, p. 4).
Case managers must not only adhere to the rules and standards of the Code, but also to the ethics codes of their primary professions (e.g., nursing, social work, vocational rehabilitation, etc.).
As for what your client is owed, you may respond, “What has the client already been promised?” Again, this approach has a legal dimension, because if your client has been promised something in a way that is legally binding on the part of the promisor, then to withhold that promised benefit when the client is legally entitled to it amounts to fraud. Consider the following example:
Example of Client Advocacy
| Case Scenario | Commentary |
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Suppose a case manager is engaged in workers’ compensation activities for a company that describes an array of return-to-work programs for employees who have been injured on the job. Presumably, the company has promised these benefits to its injured workers.
Suppose a newly hired case manager learns that:
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You may call this behavior unethical, just as you would a case manager’s resisting a client’s right to a healthcare benefit that he needs and that is clearly stipulated in his health insurance policy.
When a client has a clear need and a legal right to some service that the case manager has some involvement in or authority over, the case manager has an ethical duty to take reasonable measures to see that the client receives it. If she does not – say, because she finds herself working for an organization that is more intent on denying than providing benefits – she is clearly jeopardizing her ethical standing with CCMC and might be complicitous in a fraudulent act. She does so because she places the welfare of the company and her job retention before the welfare of her client, which is directly contrary to her basic ethical obligation of putting “the client first.” |
