In Canada, in approximately the first four months of the pandemic, deaths in long-term care facilities were twice the average of rates of any other developed country, accounting for 81% of all deaths (Szklarski, 2020). There was a gendered component, with the majority of deaths of both residents and workers being women (Armstrong et al., 2020). One participant contended that “the major impact experienced in … [residential and long-term care facilities] of the coronavirus is related to the abandonment of investments in the 15 years preceding the current government.” Researchers have argued that nursing homes have suffered from chronic underfunding, understaffing, inadequate physical structures, poor enforcement of standards, and the profit motive undermining service in some private homes (Armstrong et al., 2020; Dyer, 2020; Mitchell, 2020). These observations support the assertion that years of globalization, neoliberalism, privatization, and marketization (Giroux, 2005; Larner, 2000) have eroded the social service system for the elderly, contributing to the ethical dilemma for practitioners of providing solid practice in the midst of a crumbling system.

Not just physical health but also the psychological well-being of the elderly have been impacted (Berg-Weger & Morley, 2020). Increased isolation, inability to see or touch loved ones, confusion about disruptions and losses to routines and programmes, contribute to deteriorating emotional and cognitive health of seniors. A respondent argued, “Without any reason to live, many people would prefer to catch the virus.”

Prioritizing limited resources is an ethical challenge. Often multiple conflicting needs must be resolved. A manager in a health care setting with a respite programme was juggling the needs of caregivers stressed by “financial burdens, homeschooling burdens with their own children, [and] fears over health” with a “high risk” population of “frail elderly with numerous [co]-morbidities.” The dilemma was that “some of these clients have a high potential for ending up in the emergency” department resulting in the utilization of hospital services that were needed for the pandemic.

The complexity of determining whether the public good and the needs of the community as a whole eclipse the needs and rights of individuals was another ethical challenge. A participant described a service user, living in a senior’s residence, who received permission to go out for an appointment, but stayed out longer than expected, eating fast food while out, against the rules. On his return, he was “sent a formal notice and placed in mandatory quarantine.” He reacted with suicidal ideation and refused to take his medications, and was then threatened with Bill P-38, an Act regarding the protection of individuals whose mental state presents a danger to themselves or others. The worker felt “the residence’s … punitive actions increased the suicidal risk for M, who was already struggling with the loss of decision-making power and autonomy.” The worker “did not believe that M had exposed himself and the other residents to a high risk.” That practitioner queried, “How do we balance human rights versus collective rights? … If the measure put in place to protect is harmful, what do we do?” Furthermore, the worker questioned how much “staff shortages and general chaos within the … organization” impacted on the decisions implemented, another example of the conflict around reduced resources and the effects of neoliberalism.

Constructing and maintaining relationships when the usual means have been reduced or eliminated is another significant challenge. A participant, dressed in personal protective equipment, went to the ward of a patient requesting medical assistance in dying: “She could not see our faces, hardly see our eyes, we could not touch her, she could hardly hear us ...” The family could not be present for the discussion, leaving the worker uncomfortable with the relationship, the bedrock of social work practice.

Indigenous Peoples have fared badly in Canada since colonization (TRC, 2015) and the pandemic has only intensified those discrepancies. On First Nations reserves, as of August 12, 2020, there had been 438 confirmed cases of COVID-19 and 6 deaths (Government of Canada, 2020). The statistics for Indigenous Peoples who are living off reserve is unclear since Canada has failed to keep race-based data (Bowden, 2020); although in August, Statistics Canada sent out a questionnaire about discrimination and the impacts of COVID-19 (Statistics Canada, 2020).

Many Indigenous communities in Canada are at significant disadvantage for fighting the coronavirus. Lack of water, food insecurity, and overcrowding plague First Nations reserves (Thompson et al., 2020). In more than one hundred communities, boil water advisories have existed for years, even decades (Suzuki Foundation, 2020) making hand washing and sanitation extremely problematic. Living remotely or in poverty constricts the access to telehealth or basic necessities. A worker identified that “many Indigenous youth and families lack phone or internet services to access care virtually” reducing the opportunities for adequate care and presenting challenges for practitioners. 

Covering the huge geographic areas and resolving jurisdictional issues contribute to dilemmas for workers brought on by COVID-19. One participant was contracted as a clinical therapist to fly in and out of the North, between Canada and Europe. While in Europe, due to travel restrictions, the worker could not get clarity about whether the job was an essential service, ultimately leaving vulnerable youth without needed support. Encompassing vast territories, another participant expressed concerns about “the conditions on board the planes” for service users and/or providers.

Resources that were curtailed included normative customs and spiritual practices, an example of providing service without the necessary cultural resources. An Indigenous worker identified, “One of my clients’ bab[ies] died and it was difficult due to social distancing. [T]he family did not have a cultural gathering to honour and support the family with the loss. The baby was cremated which is not normal practice for our culture and there [were] no prayers …no sweat lodge or sacred fire.”

The history of Indigenous Peoples in Canada includes long-standing legacies of multi-generational trauma. This past has been replicated for some Indigenous practitioners and service users during the pandemic, reactivating and amplifying historical trauma. An Indigenous worker discussed a lockdown and curfew in their community implemented by their chief. The worker assessed that “This was unethical because as a culture we were treated like this in the past by Indian agents…People had no freedom and there [were] a lot of mental health issues arising from this.”

Social work’s unenviable history has contributed to the colonization, assimilation and at times death of Indigenous service users (Chapman & Withers, 2019). Massing (2017, p. 45) wrote, “in many … situations, the social work profession neither protested nor raised ethical issues. In fact, social workers were often enlisted to participate in oppressive practices.” Not wanting to repeat this traumatic history was an ethical struggle for a white manager in a child welfare agency that serves First Nations and Inuit people. That worker was involved in evaluating the safety of a child whose mother was struggling with suicidal ideation and addictions issues. The manager was well aware of “the cultural considerations that needed to [be] made” due to the “history of colonialism and First Nations people’s history with government offices” but decided that despite those very real concerns, one child had to be removed based on “the risks to the children.” Balancing the potential conflicting needs of a mother and her child is an on-going ethical challenge in child welfare but amplified within the cultural and pandemic contexts.