Autonomy Vs. Paternalism In Mental Health Treatment — страница 2

justified to speak in the best interests of their son. The energy that the Gordon’s put into advocating for what they believed, was in their son’s best interest, is a testimony to the depth of the feelings they had for their son. The agencies primary issues appeared to be their liability and responsibility. Looking at the commission’s report and attached responses from agencies (1995), it appears as though all of the agencies and practitioners involved were overly respectful of the involvement of Mr. Gordon’s family. This over-involvement with Mr. Gordon’s mother was understandable when it was disclosed that she had complained to state officials, whenever agencies did not respond in a way that she believed to be acceptable. It appears as though Mrs. Gordon understood

very well, who to speak with and what to include as pertinent information, when she desired action. As the case proceeded, it became evident that Mrs. Gordon was the most active planner of her son’s services. “Exaggerated fears and misconceptions associated with a lawsuit in high-risk clinical situations rarely bring out the best quality in practitioners.(Corey, Corey, & Callanan, 1993, p. 117). In actuality, the agencies involved were far more open to a lawsuit in terms of the lack of information that they choose to divulge to their client, Mr. Gordon. “A precaution of malpractice suit, is personal and professional honesty and openness with clients (Corey, et al., 1993, p.131).” Mr. Gordon never had the right to choose any of his treatment. He was never given all of

the information concerning the selection of choices of services, or the possible consequences of his choices. Rooney (1992) points out the need for close scrutiny of ethics whenever agencies interfere with a client’s autonomy. In an attempt to plan in Mr. Gordon’s best interest, appease Mrs. Gordon and become less liable for any poor outcomes to the treatment plan, the agencies acted paternalisticly. Agencies imposed paternalism in each of the ways cited by Rooney (1992), by opposing Mr. Gordon’s wishes of no medication. The agencies withheld information about the possible side effects of the medication he took, and the consequences of not taking medication. The agencies provided deliberate misinformation by allowing Mr. Gordon to believe that they were excluding his mother

from the planning process. Agencies were also concerned with their own perceived responsibilities for Mr. Gordon’s plan. Unfortunately, each agency choose to give as much responsibility as possible to Mr. Gordon’s family. As the history of Mr. Gordon’s treatment unfolded, it appeared evident that Mrs. Gordon was responsible for the development and supervision of Mr. Gordon’s care. She coordinated all of the service providers, and was the main contact from one provider to the next. She became the “enforcer” for the plan, and who was ultimately consulted if Mr. Gordon refused to cooperate. As agencies became more controlling of Mr. Gordon’s life (in response to Mrs. Gordon’s concerns), Mr. Gordon became more non-compliant. “Ethical dilemmas arise when there are

conflicts of responsibilities. For instance, when the agency’s expectations conflict with the concerns or wishes of the clients (Corey et al., p.135).” It appears that toward the end of Mr. Gordon’s life, none of the agencies were involved in a team approach in the delivery of services to this man. Each agency was involved in doing what they believed they were mandated to do for Mr. Gordon, and relied on Mrs. Gordon to coordinate and collaborate when necessary. The review board appeared to be most vested in singling out an agency to pronounce as responsible for the problems in the care of Mr. Gordon. Sundram (1994) writes of the changing paradigm from medical models of care to a client- centered approach to delivering services. Ironically, speaking on behalf of the same

commission who wrote the review of Mr. Gordon, Mr. Sundram focuses on the need for changes within the rank and file of service providers to empower consumers. “We need to focus on ways to promote informed, voluntary choices of people with disabilities, to provide options that allow them to meet self- identified needs” (Sundram, 1994, p.8). Yet in its’ report about Mr. Gordon (1995), the commission pointed out the agencies deficits in attempting to assure Mr. Gordon’s medication compliance, and his compliance with exams necessary to remain safely on medication. Mr. Gordon was reported by the commission to have voiced his desire to discontinue any medication for his psychiatric disorder. The commission recommended that if family involvement becomes an issue that agencies