Capacity to choose and refuse? A case study

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.