70. Case: Desperado

A few of Gary’s friends cornered you at the curling rink last week. They are very concerned about how Gary is doing and wonder why “you and the other folks you work with” aren’t doing something more for him. “Can’t you see how he is going downhill? What’s it going to take for you to intervene?” They clearly feel that Gary shouldn’t be at home, but also admit that he has rebuffed their attempts to talk to him too. Gary has refused to have meals provided, yard work done, etc. What Gary says is that he is able to do it himself, it’s his life, and why doesn’t everyone just get off his back about it?

Gary is coming in for another check-up tomorrow…and you also know that his friends will corner you again next week at the rink

What’s going on in this case?

What do you see as the key (ethics) issues?

What options do you have to address this situation?

What would you do next? Why, and what values are you using to support this approach?


Austin, W., V. Bergum, S. Nuttgens, and C. Peternelj-Taylor. 2006. A Re-visioning of boundaries in professional helping relationships: exploring other metaphors. Ethics & Behavior 16:2 77-94.

Kullnat, M. 2007. Boundaries. Journal of the American Medical Association. 297:4 343-344.

Moules, N., M MacLeod, L Thirsk, and N Hanlon, 2010. “And then you’ll see her in the grocery store”: The Working relationships of public health nurses and high-priority families in Northern Canadian communities. Journal of Pediatric Nursing 25: 327-334.

Pugh R. 2007. Dual Relationships: Personal and Professional Boundaries in Rural Social Work.  British Journal of Social Work 37: 1405-1423.

Pugh, R., B. Cheers. 2010. Rural Social Work: An International Perspective. Policy Press.

Schank J., Skovholt T. 2006. Ethical practice in small communities: Challenges and rewards for psychologists. Washington D.C.: American Psychological Association.

Townsend T. 2009. Ethics Conflicts in rural communities: privacy and confidentiality.  In W. Nelson ed. Handbook for rural Health Care Ethics: A Practical Guide for Professionals. Hanover, NH: Dartmouth College 126-141. https://geiselmed.dartmouth.edu/cfm/resources/ethics/


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