Ethical Perspective on Participation and Decision-Making
A Reflection on Munthe's lecture
Last week, I invited Christian Munthe, researcher and expert on ethics, values, and evidence issues in health, technology, and the environment. He is a Professor of Practical Philosophy at the University of Gothenburg.
He delivered a fascinating lecture based on our implementation and development of Shared Decision Making in social services, where he has been an inspiration for my knowledge and interest in the method.
Munthe's lecture captures a fascinating aspect of the ethical landscape in social work – the complex tension between decision-making capacity, participation, and autonomy. Particularly striking is how he problematizes decision-making capacity as a dynamic and situational concept rather than a static property.
In child welfare, we see this complexity clearly. A child may have good cognitive understanding but limited decision-making capacity in situations with high value conflicts or peer pressure. This creates a tension field reminiscent of the hourglass model – when theoretical principles about children's participation meet the reality of practice and complex social systems.
What truly resonates is Munthe's observation that social services handle entire family systems, which makes considerations fundamentally different compared to healthcare's more individual-centered decisions. In social services, there isn't always the clear hierarchy where one party is primary – instead, we navigate between several legitimate interests that sometimes conflict with each other.
His concept of trust-based governance where services navigate ethical gray zones without clear guidance from legislators, perfectly reflects the tension between human and machine that I often reflect upon. Systems cannot give us exact answers – instead, we as a profession must develop a collective judgment through dialogue about norms and values.
The question What is important to you? emerges as a key to creating meaningful participation even in complex situations – a way to meet as humans in a system that otherwise risks becoming too mechanical.
Perhaps the creation of this deliberative space for reflection – where both client and case worker can navigate the confusion together – is the most essential ethical act in today's pressured social services.
A short reflection on social work