Capacity to choose and refuse? A case study
| Published date | 16 November 2012 |
| Date | 16 November 2012 |
| Pages | 293-300 |
| DOI | https://doi.org/10.1108/20441281211285937 |
| Author | Susan Guthrie,Hazel Roddam,Sharmin Panna,Gordon Fairburn |
| Subject Matter | Education,Health & social care |
Capacity to choose and refuse? A case
study
Susan Guthrie, Hazel Roddam, Sharmin Panna and Gordon Fairburn
Abstract
Purpose – This paper aims to present the distinctive roles and perspectives of the members of a
multidisciplinary team supporting a man with multiple diagnoses who was under Section by the Mental
Health Act.
Design/methodology/approach – The management of risk for this man with intellectual disability,
mental illness and a degenerative neurological condition was particularly complex due to his
self-harming and impulsivity. Each specialist clinician (nurse, speech and language therapist,
psychiatrist) reflects on their role as a member of a team approach. The perspective of the man himself
is represented, although he was unable to give a consistent descriptive self report.
Findings – For people with mental illness and intellectual disability the capacity to understand and retain
information about their condition may be limited and variable. The paper discusses the multiple ethical
issues in attempting to preserve a modified autonomy and in decision making around best interests.
Practical implications – Supporting someone with dysphagia presents specific challenges to staff
teams due to the everyday and familiar nature of mealtimes. When the person is unable to understand
and refuses to comply with guidelines outlining restrictions to mealtime choices, the staff’s role in
safeguarding is particularly complex. The paper considers how to mitigate against risks to mental and
physical health.
Originality/value – In cases of self harm the care team is challenged to respect autonomy and maintain
quality of life whilst ensuring safety of the individual. The paper discusses maintaining professional
integrity when considering compromise.
Keywords Intellectual disability,Mental ill-health, Dysphagia, Neurological deterioration, Ethical issues,
Multi-disciplinary working, Learning disabilities, Mental illness, Team working
Paper type Case study
Introduction
This case study reflects on the risk assessment, treatment and care issues for a man with
intellectual disability, mental illness and a complex degenerative neurological condition,
as well as the distinctive roles and perspectives within a multidisciplinary team (MDT).
Consideration is given to issues of capacity,ethical decision-making and best interests. In this
report we have specifically focussed on the issues around referral to speech and language
therapy (SLT)for dysphagia assessment and management advice. Some people with mental
illness and intellectual disability do not have capacity to understand and retain information
about their condition, or how to mitigate against risks to their mental and physical health.
In cases of self-harm the MDT is challenged to respect autonomy and maintain quality of life
whilst ensuring the safety of the individual. Supporting someone with dysphagia presents
specific challenges to care staff teams who are asked to implement MDT guidelines
(Chadwick et al., 2003); monitoring and adapting the everyday routines in a familiar
environment but still considering the individual’s wishes (Balandin et al., 2009). When the
person is unable to understand and refuses to comply with guidelines that include restrictions
to mealtime choices, then the care staff’s role in safeguarding is particularly complex.
DOI 10.1108/20441281211285937 VOL. 6 NO. 6 2012, pp. 293-300, QEmerald Group Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
PAGE 293
Susan Guthrie is based at
Calderstones Partnership
NHS Foundation Trust and
Lancashire Care
NHS Foundation Trust,
Whalley, UK.
Hazel Roddam is based at
the University of Central
Lancashire, Preston, UK.
Sharmin Panna and
Gordon Fairburn are based
at Calderstones Partnership
NHS Foundation Trust,
Whalley, UK.
The authors wish to thank all
colleagues and clients.
To continue reading
Request your trial