Derogation of “duty of care” in favour of “choice”?
| Published date | 30 September 2013 |
| Pages | 258-270 |
| Date | 30 September 2013 |
| DOI | https://doi.org/10.1108/JAP-12-2012-0028 |
| Author | Janet Gill,Qulsom Fazil |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection |
Derogation of “duty of care”in favour of
“choice”?
Janet Gill and Qulsom Fazil
Janet Gill is a Specialist
Dietician, based at
Warwickshire Dietetic
Services, South Warwickshire
Foundation Trust,
Nuneaton, UK.
Dr Qulsom Fazil is a Lecturer
in Disability Studies and
Behavioural Science, based
at School of Clinical and
Experimental Medicine,
University of Birmingham,
Birmingham, UK.
Abstract
Purpose – Chronic health conditions such as obesity and type 2 diabetes are higher in individuals with
learning disabilities and significantly affect both quality of life and longevity. Healthy eating is an important
factor in preventing these chronic conditions. The study reported here explored the role paid carers played
in promoting healthy eating and how they managed the daily dilemma of balancing residents’ right to make
unhealthy food choices against carers’ “duty of care”.
Design/methodology/approach – Semi-structured interviews were undertaken with a purposive sample
of six residential paid carers. Interviews were transcribed and then analysed using a thematic approach.
Findings – This small study highlights the challenges that staff face when balancing food choice against
“duty of care”. It highlights that when working with less able residents, carers are motivated by “best
interests”, to place boundaries and restrictions on food access and choice. It confirms previous studies that
increased levels of choice for higher ability residents, often results in less healthy food choices. The study
describes a lack of policy, guidance and specific training for paid carers which results in them using their
personal subjective values as a basis for decision making.
Originality/value – Since the publication of “Valuing People”(Department of Health, 2001) the core
principles of residential services changed direction towards independence and choice. This study expands
our knowledge on how paid carers make sense of the everyday conflicts between choice and “duty of care”
when residents continue to make unhealthy food choices affecting their physical health.
Keywords Obesity, Learning/intellectual disabilities, Choice, Healthy eating,Paid carers
Paper type Research paper
Background
As long ago as 1995 the Department of Health highlighted the increased level of obesity in the
learning disability population in its publication “The health of the nation strategy for people
with learning disabilities” (Department of Health (DOH), 1995). Despite this publication, recent
studies have shown that these health inequalities continue, with obesity levels and associated
secondary health conditions such as cardiovascular disease and type 2 diabetes remaining at a
much higher level in people with a learning disability than those of the general population
(Melville et al., 2008; Disability Rights Commission, 2006). In the general population moderate
obesity reduces life expectancy by three years and morbid obesity by as much as ten years
with 23 per cent of vascular deaths attributable to obesity (National Obesity Observatory
(NOO), 2010).
Evidence has yet be found to indicate that in the vast majority of individuals with a learning
disability the increased levels of obesity are caused by factors other than poor lifestyle choices,
in common with the general population (Fernhall et al., 2005). There is substantial evidence,
however, that weight loss programmes which include dietary information, exercise and
behaviour modification and are adapted to an individual’s cognitive needs are successful in
promoting short-term weight loss in individuals with learning disabilities, as is the case in the
PAGE 258
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THE JOURNAL OF ADULT PROTECTION
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VOL. 15 NO. 5 2013, pp. 258-270, CEmerald Group Publishing Limited, ISSN 1466-8203 DOI 10.1108/JAP-12-2012-0028
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