What Are Dilemmas in Health and Social Care?

Dilemmas in health and social care refer to situations where there are two or more conflicting choices, each with its own set of potential benefits and downsides. Care professionals often face these circumstances when trying to do what is best for the person receiving care. The decisions can be difficult, creating uncertainty about which path to choose. These dilemmas often happen because what is best for one person might not be best for another, or because values, laws, and best practice guidance do not all point to the same course of action.

What is a Dilemma?

A dilemma arises when someone has to make a choice between options that seem equally valid but may have opposing outcomes. In health and social care, such decisions go beyond everyday problems. They often have a moral or ethical impact. A care worker could find that the right to confidentiality clashes with the need to protect someone from harm. Families might want to keep an individual at home, but medical advice could point towards residential care.

At the heart of these choices, there is often a tension between protecting rights and ensuring safety, or respecting choices and fulfilling professional responsibilities. There is rarely a single ‘correct’ answer.

Types of Dilemmas in Health and Social Care

Many types of dilemmas can arise, including those around autonomy, best interests, cultural sensitivity, consent, confidentiality, and resource allocation.

Autonomy Versus Best Interests

People receiving care have a right to make their own decisions, even if those choices could cause harm. Care workers must decide when to respect these choices and when to intervene.

Example:

Someone with capacity chooses to refuse lifesaving treatment. The care worker wants to respect this choice, but feels concerned about the outcome.

Confidentiality Versus Protection

Confidentiality means keeping information private. There are times when sharing information could prevent harm to others, yet it will break trust with the person receiving care.

Example:

A young person discloses drug use. The worker must decide whether to keep this confidential or share it to get extra help, possibly breaking trust with the young person.

Consent

Obtaining valid consent is central to good care. At times, people are unable to give valid consent, perhaps because of a learning disability or mental health condition. Professionals need to work out how to balance respect for autonomy, safeguarding, and legal frameworks such as the Mental Capacity Act 2005.

Value and Cultural Conflicts

Caregivers and those they support may hold different cultural or religious beliefs. Decisions about food choices, gender of carers, or end-of-life rituals can lead to dilemmas if personal values differ from organisational policy or legal requirements.

Allocation of Resources

Resource dilemmas affect health and social care settings, especially where funding is limited. Deciding who gets a service, and who waits, can create ethical conflict.

For example, offering a hospital bed to one patient means another might not receive care as quickly.

Causes of Dilemmas

Dilemmas are shaped by several interconnected factors. Understanding why they arise can help unpack the decisions that follow.

• Differences in individual values or beliefs
• Gaps in information or conflicting medical opinions
• Legislative requirements that may not match what families or service users want
• Limited resources versus high demand
• Advances in treatment that raise new questions about what is possible or ethical

Legal and Ethical Frameworks

Laws and professional codes are there to guide decision-making, but do not always remove every dilemma. Sometimes, what the law says must happen will not feel ‘right’ to everyone involved. Ethics refer to the ideas of right and wrong that professionals draw on when making decisions day to day.

Relevant laws and codes include:

• The Care Act 2014
• The Children Act 1989 and 2004
• The NHS Constitution
• The Human Rights Act 1998
• GMC, NMC and HCPC professional codes

These documents highlight duties like promoting wellbeing, preventing harm, respecting rights, and involving people in choices about their care.

Examples of Dilemmas in Practice

Clinical staff, social workers and support workers face dilemmas nearly every day. Here are some situations:

• A person with learning disabilities refuses to attend a medical appointment that could detect a serious illness.
• A care home resident with dementia wants to leave the building, believing she is going to visit family who have passed away.
• A terminally ill patient asks to have treatment stopped, but their family disagrees.
• Two patients need the same resource, yet only one can benefit at this time.

Each choice carries risk, and someone may feel harmed no matter which option is taken.

Common Responses to Dilemmas

Professionals use a range of strategies when dealing with these situations.

• Consulting multidisciplinary teams for shared decision-making
• Seeking legal advice if required
• Recording decisions and the reasons behind them
• Listening to all parties, especially the wishes of the person at the centre of the dilemma
• Using frameworks like ‘best interests’ (as set out in the Mental Capacity Act)

These steps help reduce the personal pressure on one worker and balance accountability.

Coping with the Emotional Impact

Facing dilemmas can cause emotional stress for staff, those receiving care, and families. Difficult choices can result in guilt if the outcome causes unhappiness.

Support for those dealing with dilemmas might include:

• Supervision from senior colleagues
• Debriefing sessions after tough decisions
• Training in communication and ethical decision making
• Access to counselling or employee support services

These practical steps can help maintain wellbeing and resilience.

Balancing Rights and Risks

The main challenge for anyone in health and social care is balancing the rights of the individual with the duty to protect them from harm. There are examples where these rights appear to be in opposition.

For example, a person with mental health problems may want to go out alone. Staff might be worried about risk of harm, but stopping someone going out could breach their human rights.

Good practice involves:

• Encouraging informed choices
• Recording discussions and decisions
• Trying different ways to reduce risk rather than simply saying “no”

The Role of Policy and Procedures

Every organisation must have clear policies and procedures. These give guidance for staff facing challenging situations. Following procedures offers some protection to staff if something goes wrong, as long as they can show they followed guidance and acted in good faith.

Common policies used include:

• Safeguarding protocols
• Consent forms and best interest decision processes
• Patient choice statements
• Escalation routes for staff who feel unsure

Factors Making Dilemmas More Likely

Some situations increase the chance of dilemmas occurring:

• Language barriers or limited communication abilities
• Cultural differences
• Fluctuating mental capacity
• Lack of family or advocate input
• Tension between medical advice and personal preferences

Where decisions are rushed, made without all relevant information, or without everyone involved being heard, dilemmas become even harder to resolve sensibly.

Case Study: A Real Example

Imagine a person with advanced dementia is in a care home. She tries to walk out of the building every day, saying she needs to collect her children from school. Staff know her children are now adults living far away. If the staff stop her, she becomes very stressed and agitated. If they allow her to leave, she would be unsafe outside on her own.

The dilemma:

• Restricting her freedom causes clear distress and potentially infringes her rights.
• Allowing her to leave may put her at risk of harm.

Staff discuss the situation in a team meeting, talk to her family and review policies. They decide to use distraction techniques and supervised walks in the garden instead of locking doors or arguing with her, aiming to reduce risks and minimise distress.

Supporting Best Practice When Facing Dilemmas

Staff can improve outcomes by:

• Keeping the person at the centre of the decision, involving them as far as possible
• Being open and honest about difficulties
• Documenting detailed reasons for decisions made
• Checking decisions against law, policy, and professional codes
• Using plain English in all communication

This approach helps to promote dignity and fairness in challenging situations.

When to Seek Support

Staff have a duty to ask for help if a situation is beyond their experience or authority. Many organisations have ethics committees or advice services to support good decision-making. Working together reduces the sense of isolation and the chance of a poor outcome.

Conclusion

Dilemmas in health and social care are part of everyday practice. These situations challenge staff to weigh up legal, ethical, cultural, family, and organisational factors, and find a balance that protects both rights and wellbeing. There are no easy answers, but careful thought, communication, teamwork and a focus on the values of respect and dignity can help make difficult choices a little clearer for all involved.