Legal, Ethical and Practice Issues in Self-Neglect - Case Study Example

LEGAL, ETHICAL AND PRACTICE ISSUES IN SELF-NEGLECT by LEGAL, ETHICAL AND PRACTICE ISSUES IN SELF-NEGLECT 0 Executive Summary This report is focused on the issue of self-neglect, with specific importance being placed on the ethical, legal and practice issues. The state-entity of choice is the UK, informed by the contested nature of the relationship between safeguarding and self-neglect in the nation. The case study will involve the perception present, about self-neglect; as informed by existing statistical analysis and research carried out. A definition and influence of self-neglect will be discussed, in light of ethical, legal and practice issues prevailing in the state. Social welfare will also be discussed, as a crucial aspect of social justice and development. Critically, will be the review of self-neglect on social cohesion and prosperity, in terms of long-term national influences and effects. Existing adult self-neglect rates in the UK, as shown by the Department of Health (DH), provides a state of contested relationship between human safeguarding and the concept of self-neglect. In part, this is due to the existing definition of abuse(s), specified in terms of harmful actions by others, aside from the individual at risk. The existing Adults Board’s procedures and policies commonly have no references to the aspect of self-neglect. The little that is present is for example, focused on drawing a distinction between inability and one’s unwillingness to maintain health. Intervention as a concept often encompasses communication channels and present safeguarding structures. This is towards information sharing, on prevailing situations of self-neglect, in addition to facilitating intervention measures. (Case study appendix 1). 2.0 Aims To increase government awareness, about the effects and influences of self-neglect within the society. The focus is on the elderly, the disabled and those challenged mentally, as these categories of individuals are of importance, in terms of their social linkage to the rest of society. Further still, is focus on the critical importance of socially inspired regard for each other and to oneself; in light to the aspect of human self-care. Objectives To establish reasons why there is a substantial percentage rate of self-neglect, within the United Kingdom’s context. This is aimed at mitigating and subsequently alleviating negative influences on both the practical and administrative aspects of self-care in the society. To improve the literacy levels and awareness on the issue of (negative) self- neglect; in terms of ethical, legal and practice issues. Pertinent measures vital for the improvement of overall self-care within the nation; in terms of public-private partnership and government intervention 3.0 Purpose of the Report The purpose of the report is to display the various influences and effects, which exist, when higher rates of self-neglect are documented in the British society. This is in terms of the ethical, legal and practical constructs pertinent to Britain’s case context; where manifestations of self-neglect exist. The development of administrative standards, protocols and recommendations will be made, aimed at enhancing overall self-care within the nation. 4.0 Background In considering the issue of self-neglect, it is defined as any failure of an individual, of mature age (adult), to take good care of herself or himself; thereby causing or having the potential of causing harm and substantial damage. In such a case as James (2000) alludes, within a short period, an individual may face serious mental, physical and emotional harm, in addition to the substantial loss, or damage of personal assets. This mainly occurs because of personal lifestyle or choice (will), in addition to the presence of other aspects such as depression, physical and mental handicaps, and poor health. (James, G.O. et al., 2000:11). As a concern, self-neglect is inclusive of amongst others: - human suffering from untreated injuries, illnesses and disease; the presence of malnutrition which may result in depraved mental and physical health, thus leading to severe impairment, and the effect of such suffering on personal property and assets. This is of significant impact in the case of property loss or damage because of subsequent dealings (Longres, 1995:74). There is also the presence of living and housing conditions, which are grossly unsanitary, and the creation of hazardous situations, which are most likely to result in serious physical harm. This harm is applicable to both the individual and society, as well as to the property or assets; in terms of loss or damage. (VCH ReAct, 2014). Different social contexts and ideals have varied beliefs on the issue of self-neglect; in addition to the effects on general society. Thus, self-neglect is viewed as a complex and serious problem, which may necessitate social, ethical and clinical decision-making; in terms of treatment and overall management (Sengstock, Jane & Rochella, and 2000:87). 5.0 Legal issues. Gibbons (2006), defines self-neglect as – the inability (either non-intentional, or intentional) by an individual, to observe and maintain culturally and socially accepted standards of self-care. Thus, there is the potential of serious consequences, on such an individual(s) health and wellbeing (Gibbons, 2006:13). As classified, self-neglect can be either intentional or non-intentional in nature. Anderson (1989) alludes to the former, occurring when an individual makes a conscious choice of personal neglect. The latter, occurs mainly because of conditions, which are health-related, thus contributing to the potential risk of self-neglect. The autonomy of an adult individual with capacity is most likely to be respected, especially about constitutional human rights, freedoms and privileges (Anderson, 1989:54). Thus, with passage of time, efforts can be directed towards the building and maintenance of supportive relationships, through which pertinent services may be negotiated. However, capacity assessments may not be able to take into full account, the complex nature of human capacity (Braye, Orr & Preston-Shoot, and 2011:183). This is informed by the fact that the distinction between executive and decisional capacity, is not found in practical terms. In the US, contexts entailing the presence of self-neglect fall under the preserve of adult protection services, the UK situation is different. Here, such contexts currently fall outside the definitive nature of its adult safeguarding structure (Mary, Patricia & Geraldine, 2013:83). 5.1 Laws on self-care Safeguarding adults entails a multi-agency responsibility, its guidance being subject to both political and public scrutiny. Accordingly, DH (2000) alludes to the focus being placed on enhanced inter-agency arrangements, towards the protection of vulnerable adults. Abuse, in such contexts, is defined as any violation on an adult individual’s civil and human rights; by another individual(s). There is also the presence of self-neglect, when there is ‘no other person’ engaged in the violation (DH, 2000). Equally, self-neglect as a concept, is in itself both contested and complex; thus requiring careful exploration. This is within the concept of empowerment principles, which underpin adult safeguarding, as well as the goals of control and choice about adult social care (Alexa, Ilie, Moroşanu, Stamos & Räihä, and 2013:78) This is regarded to amongst others, how self-neglect is conceptualized; what entails the interface between human safeguarding and self-neglect; the nature of professional interventions, and how human rights and mental capacity have an impact on prevailing conceptual frameworks (Preston, 2001:7). 6.0 Ethical issues. In terms of ethics and moral conduct, various risk factors are influential; regarding the increase of self-neglect. As Torke and Sachs (2008) allude, the elderly and those in the advancing age-bracket can suffer from different incapacities i.e. chronic illness, frontal lobe dysfunction, mental health problems and dementia. Additional factors may include: - alcohol and substance misuse, nutritional deficiency, depression and cognitive impairment. This incapacitation can unfortunately lead to social isolation, as well as the social and functional dependency of affected individuals (Torke. & Sachs, 2008:1933). As a behavioral condition, self-neglect is where an individual neglects attending to basic needs and necessities, such as personal hygiene, nutritional intake, medical health care and appropriate clothing (Mauk, 2011:60). If carried to the extreme, such cases are referred to as Diogenes syndrome; which necessitates immediate medical care (Anderson, 1989:67). To be noted, as Valory et al. (2001) allude, is that self-neglect can also be caused by other contributory factors, such as the presence of mental illness, dementia or brain injuries. Thus, it can be as a condition emanating from a given physical or mental handicap, which results in the negative effect on energy levels, physical abilities, attention, motivation and organizational skills, (Valory et al., 2001:47). An inclusion should be made on the effect of decreased motivation, also resulting from psychiatric medications; as a side effect. 6.1 Ethical Theories related to the case scenarios As provided for by the National Social Care Research Ethics Committee, existing cases of self-neglect in the UK, do present difficulties in terms of management and ethical challenges. Inter-agency action and learning plans, which are founded on individual reviews, are usually embedded within quality enhancement procedures, carried out. Useful learning is derived from periodical analysis of complete case reviews, in respect to cases of suffered abuse and/ or self-neglect (Dong & Martin, 2005:25). The deontological theory provides for human adherence, to personal duties and obligations; especially in the analysis of an ethical dilemma. Under ethical conduct, personal duty is highly regarded, where an individual follows his/her obligations to others in society (Fallon, 2006:4). Deontology provides a foundation, for which special obligations and duties are assigned to specific people, especially one’s kin (Reyes-Ortiz, 2001:119). In Utilitarian ethical theory, maintains a foundational basis on humanity’s ability to predict a given action’s consequences or end-result. Concern is placed on both rule and act utilitarianism, both of which are concerned with an individual’s performance of beneficial acts in society. the latter is concerned more with this self-less social contribution, the prevailing societal constraints i.e. laws, perceptions and beliefs notwithstanding (James, et al., 2006:41). 7.0 Governance approach towards self-neglect The British government, through enactment of the Mental Health Act, provides a better framework, on which to tackle the issue of self-neglect. It is applicable to individuals, when there is present, reasonable cause to suspect the lack of self-care. This provides ground for inter-agency government initiatives aimed at safeguarding human wellbeing; inclusive of coercive measures towards making better arrangements for the care and treatment of victims (Day, McCarthy & Leahy-Warren, and 2012:725). Individual freedoms and rights (autonomy), though being a fundamental aspect of contemporary society, can and at unique contexts, necessitate government intervention and provision of restrictive alternatives (British Medical Association & The Law Society, 1995). This may entail the removal and subsequent placement of individuals from unhygienic conditions to more sanitized environments. Human self-guarding is enhanced as a means towards overall reduction of self-neglect case rates (Gill, 2009:570). 8.0 Recommendations Mass literacy campaigns and health literacy education to be conducted, with the aim of to sensitize the public on the prevailing rates of individual self-neglect. Enhancement of health education standards, especially amongst the medical fraternity, aimed at tackling prevailing statistics of self-neglect. The improvement of access to social welfare, and funding; in the case of those individuals categorized as elderly and aged, as well as the vulnerable young and handicapped individuals. The enhancement of government intervention, through inter-agency collaboration i.e. the department of health, and social welfare agency interaction. Observance of human self-guarding, both in individual and group-entity contexts, with the aim of enhancing self-care and proper living. Public-private initiatives and collaboration, aimed at enhancing overall communal interaction and positive contributions; by way of reduced rates of self-neglect. 9.0 Summary Attainable evidence provides statistics of prevailing self-neglect within the UK. As a fact, lack of self-care is brought about by a number of factors; some individual while others are social-constructs. It is thus, the manner in which this aspect is dealt with; in terms of legal, practice and ethical contexts, which enhances the likelihood of success. Through active policy formulation and implementation; as well as enhancement of pragmatic interventions, human self-negligence can be mitigated and subsequently reduced. Reference List Alexa, ID., Ilie, AC., Moroşanu, A, Stamos, PE, & Räihä, I 2013, Self-neglect in elders: a worldwide issue ignored in Romania. Revista Romana de Bioetica, 10(1). Anderson, TB 1989, Community professionals and their perspectives on elders’ abuse. In Filinson, R. and Ingman, S., Wider Abuse: Practice and Policy, (Eds.). New York: Human Science Press. Braye, S, Orr, D, & Preston-Shoot, M 2011, Conceptualising and responding to self- neglect: the challenges for adult safeguarding. Journal of Adult Protection, The, 13(4), 182-193. British Medical Association & the Law Society. 1995, Assessment of Mental Capacity: Guidance for Doctors and Lawyers. London: British Medical Association and the Law Society. 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Valory, N.P. et al. 2001, Quantifying the Problem of Abuse and Neglect in Adults. Journal of the American Geriatrics Society, 49(1): 45-48. VCH ReAct. 2014, About Adult Abuse & Neglect: What is Self-neglect? Vancouver Coastal Health [VCH], retrieved from: http://www.vchreact.ca/read_selfneglect.htm Read More