Autonomy Vs. Paternalism In Mental Health Treatment — страница 3

deal with the families with the same diligence as other consumer issues. Yet, it appears that Mrs. Gordon had much more power than the consumer. Mrs. Gordon called the state office of mental health when she was dissatisfied. Agencies seem to have paid much diligent attention to this family. Yet, the commission and the Office of Mental Health believed that the family needed even a greater amount of attention within Mr. Gordon’s care plan. Ironically, it seems that one of the families issues in the care of Mr. Gordon was his compliance with medication. The family advocated for agency involvement and paid for private psychiatric intervention. Dr. Surles (1994) the Commissioner of the Office of Mental Health writes a year prior to this report (1995), a compelling piece on the

balance and contradictions of choice and safety. He clearly defines himself as a proponent for choice. Dr. Surles (1994) writes “We cannot demand that the public mental health system insure recipients choice and still guarantee recipients safety (p. 21).” “I simply want to note that, in the area of treatment, recipient choice means not just the right to refuse treatment, but the right to have access to treatment from which to choose (p. 22)”. In responding to the concerns of Mrs. Gordon regarding her son’s access to services, I am surprised that there is no mention by the commission to the message that agencies serving Mr. Gordon received from the Office of Mental Health’s intervention. I further question the level of the Office of Mental Health’s investigation into

the choices of Mr. Gordon in relationship to his families wish for his safety. The commission appears to be desirous to place responsibility on agencies, for Mr. Gordon’s choices. The flavor of this feels as unjust as the responsibility his family feels, and as unjust as the lack of choice Mr. Gordon felt. “Both professionals and recipients are trapped in a system that gives professionals too much responsibility and requires them to be accountable for too much (Penny, 1994, p.31).” The major conflict between the issues of choice, safety, liability, and responsibility is a philosophical conflict between autonomy and paternalism. Is freedom of choice a right that is truly inalienable and if so then should this right ever be abridged for paternalism? If choice is the right of

every citizen than all parties involved in the case of Jacob Gordon acted in an unethical and/or immoral way. The family looked upon thier child as less than a human ” To deny an individual’s autonomy is to treat that person as less than human. (Atkinson, 1991, p.106)”. The family was abusive to this person that they claimed was the object of their concern. Jacob was disrespectful and abusive to himself, in that he traded his autonomy for safety and belonging. “it is more important for humankind to exert free will, than it is to be contented (Atkinson, 1991, p.105).” In this regard, Mr. Gordon could be considered incompetent, since he was not interested in providing for himself the basic rights of his culture. The agencies involved with Mr. Gordon were unethical as:

counselors “must recognize the need for client freedom of choice (Corey et al., p. 400)”, psychologists “respect the rights of individuals to privacy, confidentiality, self-determination, and autonomy (Corey et al., p. 415)”, and social workers ” make every effort to foster maximum self-determination on the part of clients (Corey et al., p. 430)”. The Commission on Quality of care was the most unethical, as it is the mission of this agency to “require providers and appropriate State agency officials to respond to the Commission findings, and to provide periodic reports on the implementation of Commission findings, and to provide periodic reports on the implementation of Commission recommendations ( Pamphlet, New York State Commission). The recommendations that

suggested more supervision not only spoke to the issues of autonomy for Mr. Gordon, but for many other consumers served by the providers involved in this study and trained with this information. If paternalism is a societal obligation then Mr. Gordon was miserably under-served, and all parties involved in his care were irresponsible, unethical and liable for not keeping Mr. Gordon safe. The true measure of safety for Mr. Gordon would have been long term hospitalization where all of his needs could have been met. It is sad to read case studies of people struggling with normalizing life within a society that is uncertain of the issues involved in living with a psychiatric disability. My sympathy lies with Mr. Gordon, his family, and the providers involved with services for Mr.