Guardianship and Respect: Ethical Conflicts Between the Right to Life and Client Self-Determination in Medical Social Work

Abstract

Medical social work operates at the critical intersection of life and death, treatment and abandonment within healthcare settings. Practitioners frequently encounter ethical tensions between the right to life and client self-determination. The right to life emphasizes the absolute protection of individual existence, while client self-determination requires respect for clients' autonomous decisions regarding their own affairs. When clients refuse life-sustaining treatment, psychiatric patients resist hospitalization, or minors' medical wishes diverge from those of their guardians, social workers find themselves navigating complex ethical dilemmas where protection and respect are difficult to reconcile. This paper begins with conceptual clarification, examines the theoretical foundations and value hierarchies underlying both principles, and then analyzes three typical domains of tension: hospice care, compulsory psychiatric treatment, and medical decision-making for minors. Through this analysis, the study reveals the underlying relationships between the sanctity of life and quality of life, paternalism and the principle of self-determination, and institutional structural factors and professional role independence. On this basis, the paper proposes practical recommendations including establishing a hierarchical ethical order with priority to the right to life, developing a dynamic assessment mechanism for self-determination capacity, introducing multidisciplinary ethics review, and strengthening practitioners' ethical sensitivity. These recommendations aim to promote the sustainable development of medical social work practice and contribute to more ethically informed decision-making in healthcare contexts.