Case Studies / Activities

Case Study 1 with Activity

Julie is 19 years old and lives in a third floor flat with her daughter Samantha, aged 3. Julie has
had contact with social work services for a number of years as she was looked after between
the ages of 9 and 13. Although there has been the occasional time when Julie has found it
difficult to engage with social work staff, contact has generally gone very well. Julie is a likeable
and warm person who has shown remarkable resilience in the face of childhood adversity. In
recent years Julie has requested support on a number of occasions to assist with the care of
Samantha. These requests have not amounted to any ongoing involvement as Julie was
generally looking for some moral support and reassurance; particularly as to whether she was
caring for Samantha to a good enough standard. Julie has no contact with Samantha’s father
and she has a limited social support network. Julie has presented to her local social work office
in a distressed state saying that she owes a ‘loan shark’ money. She alleges that on three
different occasions two men have called at her flat and demanded repayment of the money –
approximately £150 – and that she now fears for her and Samantha’s safety. Julie requests that
the duty social worker does something to help her; specifically she wants a loan from the social
work office. She indicates that if no help is forthcoming she is not sure how she can go on and
that it would be better for both her and Samantha to be gone for good.

1. Identify the power that Julie holds within this exchange.

Case Study 2: Kelvin - The Untold Truth

At 30 years old, Kelvin is at the prime of his life, holding a good position as a financial advisor in a foreign
bank. He is also preparing to marry his fiancée of 10 years after much prudent planning for his marriage
and waiting for their HDB Built-To-Order flat to be ready by the end of 2011. Little does he expect to
suffer a relapse of colon cancer and be admitted to the hospital so soon. His illness was first diagnosed 6
years ago and in 2009, he went through a major surgery; a surgery that gave him only a 50% chance of
recovery. Being a Christian and actively involved in his church since 1996, Kelvin then had a positive
outlook on life and the surgery turned out to be a great success, allowing him to recover well.
Unfortunately, this relapse in April 2011 unveils cancer cells that have spread to his bladder, and the
prognosis is poor, averaging between 3–6 months to live according to his doctor. Kelvin is the youngest in
a family of four siblings. He is staying with his second sister and her family, while his parents and two
other married siblings live in the same block but on different levels. The family is a close-knit household,
with the children coming home regularly for meals. His mother, Mrs. Tan, is devastated by her son’s
current relapse and is distressed by his condition. She expresses her grief at having her youngest son,
who is obedient and filial, doing well in his career, and about to get married in May 2011, suffer “this
terrible curse”. The oncologist-in-charge, Dr Malcolm, is reluctant to release the news of the prognosis to
Kelvin and his family. The main reason for Dr Malcolm’s unwillingness to do so stems from Kelvin’s overly
positive attitude that he will recover from his illness. Believing that miracles and healing can happen
again, the bridegroom has begun his wedding preparations, trying on his wedding suit and pestering the
hospital to discharge him soon. His fiancée, another devout Christian, also believes that Kelvin will heal
with “God’s help and grace”. Colleagues and church friends are, nevertheless, also supportive and visit
him often in the hospital. The couple has plans for their future, based on To Tell or Not To Tell the
premise that Kelvin will recover; there is never a doubt in their minds about Kelvin’s recovery. Jane, their
assigned medical social worker, is informed by Dr Malcolm that Kelvin has not been told that he is
terminally ill; neither has his family. In a hospital-based setting, it is usually the doctor who releases the
diagnosis to the patient and his/her family but Dr Malcolm has taken an unusual stance of choosing not
to reveal the severity of the relapse to Kelvin—and this puts Jane in a dilemma. In Jane’s area of work,
she is expected to provide psychosocial support and counseling to patients and their families. This
includes managing expectations of the illness of both the patient and the family, looking at possible
financial issues when it comes to medical expenses, loss of employment and income issues, advanced
care planning and discussing with those concerned about their perceptions toward end-of-life care. As
for Kelvin, Jane is assured that he is financially prepared for his hospitalization and treatment expenses,
given his training as a financial advisor; and he has been frugal all this while as he has been saving for his
marriage and new flat. However, Jane is skeptical that Kelvin is emotionally prepared for a terminal
illness after having a brush with death in 2009. His mother is already an emotional wreck, displaying
difficulties accepting Kelvin’s current relapse and fearing that she will not be able to cope with his illness
upon discharge. She needs a great deal of emotional support from the social worker. Meanwhile, Kelvin’s
fiancée has been kept busy with their marriage preparations, genuinely believing that a miracle will
happen: that Kelvin will recover.

Questions: What would you do if you were Jane? Would this be an ethical dilemma for you as it is for
Jane? Would you persuade Dr Malcolm to reveal the prognosis to Kelvin or perhaps to his family? Or
would you override Dr Malcolm’s decision of not wanting to reveal the prognosis and reveal it to Mrs.
Tan, Kelvin or his fiancée? What if Mrs. Tan stops you in the ward dormitory during one of your To Tell or
Not To Tell 10 rounds to ask what Kelvin’s prognosis is? What would you tell her exactly?