Research on the Ethical Dilemma of Client Self-Determination in Elderly Social Work Practice

文章聚焦中国老年社会工作中由案主自决原则引发的伦理困境及其本土化应对路径。老年群体因身心衰退、决策能力受限及多元角色冲突，其自决权常与安全保护、完全照料等需求尤其在临终关怀场景中产生矛盾。困境成因主要涵盖社会工作者专业水平不足影响伦理决策能力、老年案主自主能力弱化导致权益易被忽视，以及多元利益相关者角色复杂引发价值冲突三方面。对此，研究提出系统解决路径：政府层面需加强政策支持、完善法律法规并提升社会认同；人才建设方面应强化专业培训、督导机制及职业化水平；实务操作中，社会工作者需弹性落实个案福祉，即在尊重老人知情权基础上灵活干预以平衡自决与保护；建立平等友好的专业关系，避免父权主义并激发案主潜能；严格遵循个别化原则定制干预方案。研究最终倡导立足本土实践，总结中国语境下的经验，以推动老年社会工作伦理困境的有效化解和专业发展。This article focuses on the ethical dilemma caused by the principle of self-determination of case owners in elderly social work in China and its localized response path. Due to physical and mental decline, limited decision-making abilities, and conflicting roles, the right to self-determination of the elderly often conflicts with their needs for safety protection, complete care, and other aspects, especially in end-of-life care settings. The causes of the dilemma mainly include three aspects: insufficient professional level of social workers affecting ethical decision-making ability, weakened autonomy of elderly case owners leading to the neglect of their rights, and complex roles of multiple stakeholders causing value conflicts. In this regard, the study proposes a systematic solution path: the government needs to strengthen policy support, improve laws and regulations, and enhance social recognition; in terms of talent development, professional training, supervision mechanisms, and professionalization levels should be strengthened; in practical operation, social workers need to flexibly implement individual welfare, that is, to intervene flexibly on the basis of respecting the elderly’s right to know, in order to balance self-determination and protection; establish equal and friendly professional relationships, avoid patriarchy, and stimulate the potential of clients; strictly follow the principle of individualization to customize intervention plans. The research ultimately advocates based on local practices, summarizing experiences in the Chinese context, in order to promote effective resolution of ethical dilemmas in elderly social work and professional development.