Ugly Power

I struggle with the balance between 'best interest of the client' and 'best interest of the agency'. I often internalise the latter as my M.O. Carniol suggests that taking sides with one's employer over one's clientele is related to class links and some internal desire for power, what I see as a nod to Nietzsche.
Whatever the reason, I do it often. So often that I don't notice it and have come to accept this style as normal and expected. I am, of course, most comfortable in a position of power and presumed knowledge.
I have patient right now who is dying. This is nothing new, they all die and they all die horribly. But this guy, with some pressure from siblings, chose to return to his home community to die. It's remote, it has very few adequate care options, but he's with family and he reports that he's happy.
But I'm not happy and I can't seem to let that go. I find that I am always looking for reasons to drag him back to Vancouver so that we can medicalise his death in a facility. I know at the same time that this is no way to spend your final days. In my heart I am fundamentally opposed to unnecessary medical intervention (I'm sure this will come up in a later post - it's what I do for a living for God's sake). But I am drunk with potential power. Because I have the authority to force him to come back, I can't relax. I want to exert that authority.

It really is an admission of nasty guilt. But I know I am not alone in maintaining this kind of dilemma in my mind. In mental health care, child welfare, probation, etc. social workers are capable of drastically altering people's lives with the simple stroke of a pen or keyboard. We can make or break people, in other words. I am convinced that sometimes we break people just because we can. That is f***ing scary. It goes against everything we believe in, everything that social work is meant to uphold. Or does it? Aren't we just arms of the state which always operates in its own best interest?

Up is Down

In an elevator going up to the seventh floor yesterday I debated graduate school with a nurse who just completed her BScN.
Nursing is a technical trade, I said. It makes perfect sense to me that one ought to hone that skills through further school and field practice. It can only make you a better nurse and a better teacher to others. Social work, on the other hand, is a value or a worldview. It is a set of beliefs about justice that inform how you live your life and interact with others. Many of these beliefs can be instilled in the individual through lessons on history and injustice. The student must be 'pushed' almost over the breaking point of existential agony before s/he can begin the battle for social justice.
MSWs and PhDs in social work are therefore useless, I argued. But you're doing your MSW now, she countered.
True. And I admitted it was about a combination of money and prestige. These are personal failings. So here's the dilemma of the day: if more learning simultaneously and potentially increases my understanding of social failings while also limiting my own experience of those social failings (by raising my standard of living), ought I to continue? In other words, the more I understand, the more power I have and the more distance is created between me and powerless people - those I have pledged to fight for.