Essay, Research Paper
Autonomy Vs. Paternalism In Mental Health Treatment
The assignment for this Ethics category was to reexamine Mr. Jacob & # 8217 ; s intervention,
as described by the New York State Commission on Quality of Care for the
Mentally disabled ( 1994 ) . The category was further asked to notice on the major
issues for each of the three positions. The bureaus, household and reappraisal
board were to be included. This pupil will get down with a 4th position ;
that of Mr. Gordon.
In the Matter of Jacob Gordon ( 1994 ) , is the narrative of the last eight old ages
of a psychiatrically handicapped adult male & # 8217 ; s life. Mr. Gordon appeared to hover
between endeavoring for liberty and accepting the support of his household.
Unfortunately, it appeared by this history that the households support was non
synonymous with liberty. It did non look that Mr. Gordon had of all time desired or
sought bureau intercession for himself. Mr. Gordon & # 8217 ; s association with the
mental wellness system appeared to be marked by power and control issues.
& # 8220 ; Consumers/ex-patients frequently report a feeling of & # 8220 ; invisibleness & # 8221 ; ; they sense that
their positions and desires do non count ( Carling, 1995, p.79 ) . & # 8221 ;
The committee & # 8217 ; s study ( 1995 ) radius of several incidences where Mr. Gordon
eluded to his desire for liberty. Mr. Gordon did non wish to populate in a
supervised scene. Mr. Gordon did non wish to go to group twenty-four hours intervention
scenes. Mr. Gordon did non wish to utilize medicine in the intervention of his
mental wellness upset. Without medicine his behaviour was deemed unacceptable
and did non allow him the chance to hold any of these picks. & # 8220 ; Choice is
a right-not a privilege to be afforded by good behaviour ( Penny, 1994, p. 29 ) . & # 8221 ;
Mr. Gordon & # 8217 ; s right of pick was limited even though he lived in his flat
independently. The status of his flat was scrutinized. His medicine
was closely monitored ; sometimes to the grade that he was directed to go forth his
place to have medicine that was given to him oppress, in an effort to
insure it & # 8217 ; s consumption. & # 8220 ; Even peoples autonomies in a extremely controlled board and
attention place may be barely greater than in a infirmary ward ( Rubenstien, 1994,
p.54 ) . & # 8221 ; In Mr. Gordon & # 8217 ; s instance even within the holiness of his ain place, his
autonomies were barely greater than in a infirmary ward.
Other than his liberty the 2nd issue for Mr. Gordon appears to be the
demand for safety and support. For this, Mr. Gordon turned to his household. The
study ( 1994 ) points out that Mr. Gordon requested his female parent be limited in her
ability to entree personal information. He continued to necessitate her support and
aid although this met she continued to be excessively involved in his life.
It was his female parent he turned to when he had jobs with a roomie. It was his
female parent who was utilized when Mr. Gordon was less compliant. It was Mr. Gordon & # 8217 ; s
household who assured that he had continued mental wellness guidance and services.
It was besides Mr. Gordon & # 8217 ; s household who appeared to be the focal point of any programs
for Mr. Gordon. & # 8220 ; & # 8230 ; & # 8230 ; outlooks, shortly to be dashed by plans more devoted
to serving neurotic households than people with schizophrenic disorder & # 8221 ; ( Rubenstien, 1994,
p.55 ) . Mr. Gordon remained safe and close to his household by releasing his
Mr. Gordon & # 8217 ; s safety was the most of import issue for the household.
Secondarily to his safety, Mr. Gordon & # 8217 ; s household wished him to hold the
chance to take part in scheduling that would help in his health.
For Mr. Gordon & # 8217 ; s household, health seemed to compare to a criterion of behaviour
that his female parent personally viewed as normal.
The household were non bound to any codification of moralss or compelled to understand
their prejudices or biass in their boy & # 8217 ; s instance. Surely, to state that the
household operated on the premiss of paternalism is an understatement. Ethically,
the Gordon & # 8217 ; s believed that they were the most justified to talk in the best
involvements of their boy. The energy that the Gordon & # 8217 ; s set into recommending for
what they believed, was in their boy & # 8217 ; s best involvement, is a testimony to the
deepness of the feelings they had for their boy.
The bureaus primary issues appeared to be their liability and
duty. Looking at the committee & # 8217 ; s study and affiliated responses from
bureaus ( 1995 ) , it appears as though all of the bureaus and practicians
involved were excessively respectful of the engagement of Mr. Gordon & # 8217 ; s household. This
over-involvement with Mr. Gordon & # 8217 ; s female parent was apprehensible when it was
disclosed that she had complained to province functionaries, whenever bureaus did non
respond in a manner that she believed to be acceptable. It appears as though Mrs.
Gordon understood really good, who to talk with and what to include as pertinent
information, when she desired action. As the instance proceeded, it became apparent
that Mrs. Gordon was the most active contriver of her boy & # 8217 ; s services.
& # 8220 ; Exaggerated frights and misconceptions associated with a case in high-risk
clinical state of affairss seldom conveying out the best quality in practicians. ( Corey,
Corey, & A ; Callanan, 1993, p. 117 ) . In actuality, the bureaus involved were
far more unfastened to a case in footings of the deficiency of information that they choose
to unwrap to their client, Mr. Gordon. & # 8220 ; A safeguard of malpractice suit, is
personal and professional honestness and openness with clients ( Corey, et al. , 1993,
p.131 ) . & # 8221 ;
Mr. Gordon ne’er had the right to take any of his intervention. He was
ne’er given all of the information refering the choice of picks of
services, or the possible effects of his picks. Rooney ( 1992 ) points out
the demand for close examination of moralss whenever bureaus interfere with a
client & # 8217 ; s liberty. In an effort to program in Mr. Gordon & # 8217 ; s best involvement, appease
Mrs. Gordon and go less apt for any hapless results to the intervention program,
the bureaus acted paternalisticly. Agencies imposed paternalism in each of the
ways cited by Rooney ( 1992 ) , by opposing Mr. Gordon & # 8217 ; s wants of no medicine.
The bureaus withheld information about the possible side effects of the
medicine he took, and the effects of non taking medicine. The bureaus
provided calculated misinformation by leting Mr. Gordon to believe that they
were excepting his female parent from the planning procedure.
Agencies were besides concerned with their ain perceived duties for
Mr. Gordon & # 8217 ; s program. Unfortunately, each bureau take to give as much
duty as possible to Mr. Gordon & # 8217 ; s household. As the history of Mr.
Gordon & # 8217 ; s intervention unfolded, it appeared apparent that Mrs. Gordon was
responsible for the development and supervising of Mr. Gordon & # 8217 ; s attention. She
coordinated all of the service suppliers, and was the chief contact from one
supplier to the following. She became the & # 8220 ; enforcer & # 8221 ; for the program, and who was
finally consulted if Mr. Gordon refused to collaborate. As bureaus became more
commanding of Mr. Gordon & # 8217 ; s life ( in response to Mrs. Gordon & # 8217 ; s concerns ) , Mr.
Gordon became more non-compliant. & # 8220 ; Ethical dilemmas arise when there are
struggles of duties. For case, when the bureau & # 8217 ; s outlooks
struggle with the concerns or wants of the clients ( Corey et al. , p.135 ) . & # 8221 ; It
appears that toward the terminal of Mr. Gordon & # 8217 ; s life, none of the bureaus were
involved in a squad attack in the bringing of services to this adult male. Each
bureau was involved in making what they believed they were mandated to make for Mr.
Gordon, and relied on Mrs. Gordon to organize and join forces when necessary.
The reappraisal board appeared to be most vested in singling out an bureau to
pronounce as responsible for the jobs in the attention of Mr. Gordon. Sundram
( 1994 ) writes of the altering paradigm from medical theoretical accounts of attention to a client-
centered attack to presenting services. Ironically, talking on behalf of the
same committee who wrote the reappraisal of Mr. Gordon, Mr. Sundram focuses on the
demand for alterations within the rank and file of service suppliers to authorise
consumers. & # 8220 ; We need to concentrate on ways to advance informed, voluntary picks of
people with disablements, to supply options that allow them to run into self-
identified demands & # 8221 ; ( Sundram, 1994, p.8 ) . Yet in its & # 8217 ; study about Mr. Gordon
( 1995 ) , the committee pointed out the bureaus shortages in trying to guarantee
Mr. Gordon & # 8217 ; s medicine conformity, and his conformity with tests necessary to
remain safely on medicine. Mr. Gordon was reported by the committee to hold
voiced his desire to stop any medicine for his psychiatric upset.
The committee recommended that if household engagement becomes an issue that
bureaus trade with the households 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 province office of mental wellness when she was dissatisfied.
Agencies seem to hold paid much persevering attending to this household. Yet, the
committee and the Office of Mental Health believed that the household needed even
a greater sum of attending within Mr. Gordon & # 8217 ; s attention program.
Ironically, it seems that one of the households issues in the attention of Mr.
Gordon was his conformity with medicine. The household advocated for bureau
engagement and paid for private psychiatric intercession. Dr. Surles ( 1994 )
the Commissioner of the Office of Mental Health writes a twelvemonth prior to this
study ( 1995 ) , a compelling piece on the balance and contradictions of pick
and safety. He clearly defines himself as a advocate for pick. Dr. Surles
( 1994 ) writes & # 8220 ; We can non demand that the public mental wellness system insure
receivers pick and still warrant receivers safety ( p. 21 ) . & # 8221 ; & # 8220 ; I merely
privation to observe that, in the country of intervention, recipient pick means non merely the
right to decline intervention, but the right to hold entree to intervention from which
to take ( p. 22 ) & # 8221 ; . In reacting to the concerns of Mrs. Gordon sing her
boy & # 8217 ; s entree to services, I am surprised that there is no reference by the
committee to the message that bureaus functioning Mr. Gordon received from the
Office of Mental Health & # 8217 ; s intercession. I farther inquiry the degree of the
Office of Mental Health & # 8217 ; s probe into the picks of Mr. Gordon in
relationship to his households wish for his safety.
The committee appears to be wishful to put duty on bureaus,
for Mr. Gordon & # 8217 ; s picks. The spirit of this feels every bit unfair as the
duty his household feels, and every bit unfair as the deficiency of pick Mr. Gordon
felt. & # 8220 ; Both professionals and receivers are trapped in a system that gives
professionals excessively much duty and requires them to be accountable for
excessively much ( Penny, 1994, p.31 ) . & # 8221 ;
The major struggle between the issues of pick, safety, liability, and
duty is a philosophical struggle between liberty and paternalism. Is
freedom of pick a right that is genuinely unalienable and if so so should this
right of all time be abridged for paternalism? If pick is the right of every citizen
than all parties involved in the instance of Jacob Gordon acted in an unethical
and/or immoral manner. The household looked upon thier kid as less than a human & # 8221 ;
To deny an single & # 8217 ; s liberty is to handle that individual as less than homo.
( Atkinson, 1991, p.106 ) & # 8221 ; . The household was opprobrious to this individual that they
claimed was the object of their concern. Jacob was disrespectful and opprobrious to
himself, in that he traded his liberty for safety and belonging. & # 8220 ; it is more
of import for world to exercise free will, than it is to be contented ( Atkinson,
1991, p.105 ) . & # 8221 ; In this respect, Mr. Gordon could be considered incompetent,
since he was non interested in supplying for himself the basic rights of his
civilization. The bureaus involved with Mr. Gordon were unethical as: counsellors
& # 8220 ; must acknowledge the demand for client freedom of pick ( Corey et al. , p. 400 ) & # 8221 ; ,
psychologists & # 8220 ; esteem the rights of persons to privateness, confidentiality,
self-government, and liberty ( Corey et al. , p. 415 ) & # 8221 ; , and societal workers & # 8221 ;
do every attempt to further maximal self-government on the portion of clients
( Corey et al. , p. 430 ) & # 8221 ; . The Commission on Quality of attention was the most
unethical, as it is the mission of this bureau to & # 8220 ; require suppliers and
appropriate State bureau functionaries to react to the Commission findings, and to
supply periodic studies on the execution of Commission findings, and to
supply periodic studies on the execution of Commission recommendations (
Pamphlet, New York State Commission ) . The recommendations that suggested more
supervising non merely spoke to the issues of liberty for Mr. Gordon, but for
many other consumers served by the suppliers involved in this survey and trained
with this information.
If paternalism is a social duty so Mr. Gordon was miserably
under-served, and all parties involved in his attention were irresponsible, unethical
and apt for non maintaining Mr. Gordon safe. The true step of safety for Mr.
Gordon would hold been long term hospitalization where all of his demands could
have been met.
It is sad to read instance surveies of people fighting with normalizing life
within a society that is unsure of the issues involved in life with a
psychiatric disablement. My sympathy lies with Mr. Gordon, his household, and the
suppliers involved with services for Mr. Gordon. I am regretful that the field of
psychological science is so probationary about the types of intervention that assist people in
retrieving from mental unwellness. Mr. Gordon surely ne’er appeared to be
relieved from his symptoms to a grade that was comfy during the old ages
reported. His ends were aimed at normalising his life, the same ends as every
other participant in this calamity. Mr. Gordon & # 8217 ; s aims in making that end
were at odds with the other members of his intervention squad.
The Gordon household surely deserves acknowledgment for the function they played
in being available and supportive of Mr. Gordon & # 8217 ; s recovery. Mrs. Gordon seems
the type of individual that would hold done anything to help her boy in his
health, anything except hazard injury to him. I empathize with her feeling of
fright that her boy was non having what he needed.
The head-shrinker involved in Mr. Gordon & # 8217 ; s attention seems to be instead
cryptic, as we have small information about this supplier. Frustration is
inevitable when covering month on terminal with a patient that shows small advancement
in decreasing the symptoms of his unwellness. Regardless of the sum of success
therapy yielded the physician ne’er abandoned his client. As Mrs. Gordon was
highly pro-active in her boy & # 8217 ; s intervention, the physician & # 8217 ; s continuity was
Last, the service suppliers worked reportedly infinite hours to help
Mr. Gordon in going independent. In malice of the maze of regulations and
ordinances and concerns for behavior, these people gave Mr. Gordon unconditioned
attention. The study reflects the maneuvering bureau staff attempted to help Mr.
Gordon in accepting attention that they believed would give him the life style he
wanted. I suspect that each of those bureaus, at one clip, gave Mr. Gordon all
they could to guarantee his liberty and his safety. Since these constructs do non
mix, they worked in ineffectual attempt and likely were cognizant of this.
Mr. Gordon & # 8217 ; s instance will go of import in the manner services are delivered,
when either the Torahs provide for consumers rights to picks and
duties, or bureaus duties to do picks and go responsible
for the consumers safety.
& # 8220 ; Can & # 8217 ; t you give me brains? & # 8221 ; asked the straw man.
& # 8220 ; You don & # 8217 ; t necessitate them. You are larning something everyday. A babe has encephalons,
but it doesn & # 8217 ; t cognize much. Experience is the lone thing that brings cognition,
and the longer you are on earth the more you are certain to acquire & # 8221 ;
The Wizard of Oz Frank L. Baum
Atkinson, J. ( 1991 ) . Autonomy and mental wellness. In P. Barker & A ; S. Baldwin
( Eds. ) , Ethical issues in mental wellness ( pp.103-125 ) . New York: Chapman & A ; Hall. Carling,
P.J. ( 1995 ) .
Tax return to Community Building Support Systems for People with Psychiatric
Disabilities. New York: The Guilford Press. New York State Commission on
Quality of Care for the Mentally Disabled, ( 1995 ) .
A Report. In The Matter of Jacob Gordon: Confronting the Challenge of Supporting
Persons With Serious Mental Illness in the Community. New York:
Commission on Quality of Care for the Mentally Disabled. New York State
Commission on Quality of Care for the Mentally Disabled.
A Pamphlet. What is The Commission? New York: Commission on Quality of
Care for the Mentally Disabled. Corey, G. , Corey, M.S. , Callanan, P. ( 1993 ) .
Issues and Ethical motives in the Helping Professions. ( 4th ed. ) . California:
Brook/Cole Publishing Co. Penny, D.J. ( 1994 ) .
Choice, common sense, and duty: the systems duties to
receivers. In C. J Sundram ( Ed. ) , Choice & A ; Responsibility ( pp. 29-32 ) . New
York: NYS Commission on Quality of Care for the Mentally Disabled. Rooney,
R. ( 1992 ) .
The ethical foundation for work with nonvoluntary clients. Schemes for
Work with Involuntary Clients. ( pp. 53-74 ) . New York: Columbia University
Press. Sundram, C.J. ( 1994 ) .
A model of believing about pick and duty. In C. J.
Sundram ( Ed. ) , Choice & A ; Responsibility ( pp. 3-16 ) . New York: NYS Commission
on Quality of Care for the Mentally Disabled. Surles, R.C. ( 1994 ) .
Free pick, informed pick, and unsafe picks. In C.J. Sundram
( Ed. ) , Choice & A ; Responsibility ( pp. 17-24 ) . New York: NYS Commission on
Quality of Care for the Mentally Disabled.