Scenarios for
ethical decision-making

A disabled adult wants to continue living with a partner, while whānau and support workers notice signs of possible psychological abuse. (Psychological abuse could show up as a pattern of coercion, intimidation, gaslighting or manipulation.) The adult insists they are safe and refuses help. 

Ethical tension: Respecting their decision (autonomy) vs Acting to prevent possible harm (duty of care).  

NZ relevance: SAFA encourages person-directed approaches to ensure the person is making informed decisions, while assessing risk and co-ordinating a multi-agency team response when necessary.   

Source: PASAT.

A support worker is told in confidence that a flatmate has been threatening disabled person. The disabled person begs the support worker not to share the information.  

Ethical tension:

• Protecting confidentiality vs  

• Reporting concerns to prevent violence or neglect.   

NZ relevance: Disability Support Services (DSS) requires providers to prevent, identify, and respond to abuse, even when disclosure is difficult.   

Source: DSS.

Scenario A:  

A person identifying as  tāngata whaikaha Māori wishes to manage their own finances, but a provider believes they are vulnerable to financial exploitation.  

Ethical tension:

• Supporting the person to develop skills and confidence, and manage their own affairs
  vs  

• intervening to protect them from financial exploitation and harm.   

NZ relevance:

Effective safeguarding stresses that disabled people have the right to make decisions and take risks, noting that support must be provided, if needed.  

Source: New Zealand Disability Support Network (NZDSN).

Scenario B:

A disabled woman is living at home with a parent who provides 90% of her daily supports (paid via Individualised Funding). The parent is making the day-to-day decisions for her, including who she can visit, which friends she can have over, and who she can communicate with and how. 

Ethical tension

• Substitute decision-making (where the parent feels in control) 
  vs

• Supported decision-making (where the disabled person can exercise their own will and preference). 

NZ relevance: 

Controlling another person’s ability to communicate is a type of abuse. See definitions of abuse. 

Disabled people must have the support they need to make informed decisions affecting all aspects of their life. They must be free to direct their own choices and decisions, enabled by supported decision-making if helpful.  

Source: New Zealand Disability Support Network (NZDSN).

Scenario:

A disabled person (identifying as tagata sa'ilimalo) who is also meeting the definition of an Adult at Risk prefers that all decisions involve their extended family, but an NGO’s policy requires the discussion of personal safety matters in private, first, with one nominated family member or support person (in situations where an adult isn’t able to make their own decisions).  

Ethical tension:

• Respecting cultural practices and collective decision-making 
  vs  

• Adhering to organisational privacy policies and individual rights standards.  

NZ relevance:

Safeguarding principles emphasise respect for identity, culture, and whānau-centred approaches. This means that the Pasifika person’s wishes and preferences must be honoured.  

Source: New Zealand Disability Support Network (NZDSN).

Notes: 

Keep in mind that legal requirements may mean that one responsible person must be identified as the decision-maker (for example, only one person can sign a form, directing whether or not to go ahead with surgery). 

Ideally, this would need to be worked through in advance, with the Adult at Risk. What happens if there is no Enduring Power of Attorney (EPOA) in place?  

If the person is deemed to not have capacity, and there is an important decision pending, like medical treatment, buying or selling property, moving into a residence, a legal process of applying for orders under PPPR Act will be started and all relevant family members will have a say in who is appointed Welfare Guardian or Property Administrator. Smaller decisions can be discussed with the whānau/aiga. 

Scenario:  A support worker notices a colleague speaking harshly to a person they support and ignoring their basic care needs.  

Ethical tension:

• Maintaining collegial relationships  
  vs  

• Reporting neglect to management or DAPAR services.  

NZ relevance: Disability Support Services (DSS) requires providers to prevent, identify, and respond to abuse, even when disclosure is difficult. Source: DSS.

Whaikaha / the Ministry of Disabled People highlights obligations to strengthen reporting systems, including complaints and incident reporting, to uphold safety.  

Source: Whaikaha.