Autonomy and Beneficence: Guardrails for Case Management Practice

Professional case managers, particularly those who are board certified, are obliged to uphold several ethical principles as outlined in the Code of Professional Conduct for Case Managers, from the Commission for Case Manager Certification (CCMC). These principles include autonomy and beneficence, which I will address in this column.

Autonomy seeks to preserve and uphold a client’s right to self-determination. This means individuals have the right to make informed decisions in support of their goals. Beneficence compels case managers to show compassion while taking action to promote the welfare of the client and their support system.

These two principles go together, like twin guardrails that help case managers navigate through the complexities of each case as they advocate for clients. As the Code states, Certified Case Managers (CCMs) “understand and commit to quality for clients, appropriate use of resources, and empowerment of clients in a manner that is supportive and objective.”

Michelle Baker, BS, RN, CRRN, CCM, is a Commissioner and a former chair of the CCMC, the first and largest nationally accredited organization that certifies case managers. She is also Director, Clinical Network Operations, for Paradigm. Her primary areas of focus include managing workers’ compensation catastrophic nurse case managers and ensuring program development/implementation, and training the clinical network.

There are times, however, when a catastrophic injury or illness impacts how autonomy and beneficence can best be carried out by the case manager. While the client’s choices and decisions still need to be respected and supported, the case manager is also ethically obligated to minimize unreasonable risks to the client. Risks might include potential injuries, such as burns or falls, that could occur if the client fails to realize or accept that their physical and/or cognitive abilities are impaired.

An example is a 21-year-old man who suffered a traumatic brain injury. As an adult, this individual had no legal guardian, and yet did not have the capacity to make informed decisions on his own behalf. The principle of autonomy precludes the case manager from stepping in and making decisions for the client. Instead, the case manager needed to identify someone in the client’s support system to help him understand the circumstances, weigh the options, and make informed decisions, while guardianship or other legal appointments such as medical power of attorney could be arranged.

Information—But Not Undue Influence

Beneficence obligates case managers to do good for the client. This means ensuring that the welfare of the client and their support system is appropriate. One way beneficence is carried out is providing education and information to promote the client’s self-care and support independence.

Case managers can engage other care providers—such as primary care physicians, internists, psychologists, rehabilitation counselors, dieticians, and others—to help educate the client. There is no guarantee, however, that the client will act on that information. Autonomy means the individual has the right to make their own choices, even when those decisions or actions are not what the case manager views as prudent or the “right thing” to do.

This sets up a challenge for case managers who typically come from helping professions such as nursing, social work, counseling, and similar backgrounds. Because of their education, training, and experience, case managers have a wealth of information to share. But their support and advice cannot cross the line into undue influence. Autonomy means the client and the support system have the final word continues on page 33