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Question 1: What are the ethical concepts pertaining to freedom, rights, responsibilities and the use of power in care which apply to this situation and what kind of strategies could the staff employ to support and respect Mrs. McDonahue’s dignity? Consider how the staff can maintain effective communication and use their interpersonal skills including compassion, dignity and respect to deliver the best care possible to Mrs. McDonahue?
The issue of right, responsibility and ethics are both universal ideals and also ideals which are relevant to specific situations. In cases like these, all the aspects of the situation should be carefully considered before coming to a decision which best serves the ideals of ensuring rights and taking full responsibility. In the case of Mrs. McDonahue, power is also an important component as she is powerless in several aspects of her life and has to be helped by the workers in the care home that she is in.
In the case of Mrs. McDonahue, understanding her rights with respect to what she can and cannot do in the care home needs to be understood from a differentiated point of view. Kamm (2008) suggests that there is a difference between legal and moral rights. Legal rights are the rights which have been put in place by the legal system of the country. Moral rights, on the other hand, may not have any legal basis to them, but they are a set of universal human rights that every human being should possess and also endeavour to give others. In the case of Mrs. McDonahue, perhaps the care workers can only fulfil the duties which is required of them by the law, by feeding her, clothing her and giving her medication. Kamm says that rights and duties are intricately connected and because of the inherent rights that a person has, other people have a duty to fulfil those rights. Hence, from this we can infer that responsibility is intricately linked to the ideal of rights, where the responsibility which streams from the moral system that gives way to duties.
The idea of ethics with relation to rights and responsibilities can be distinguished between claims and duties and liberties. According to Wesley Hohfeld, a legal philosopher, claims and duties are what we owe to everyone around us. We cannot do anything we would like to do because our actions are attached to the wellbeing of others around us. The second aspect is liberty, whereby individuals may see to do with their life or the life of people they are responsible for the way they see fit. For example, a guardian may choose to discipline their child the way that they see fit. It is not the responsibility of anyone to tell the guardian how they can and cannot discipline the child. However, he adds, that the liberty is not valid when someone makes a claim that you’re trespassing on someone else’s or their liberty (The Ethics Centre, June 2 2017). Relating this to the case of Mrs. McDonahue, the ethical perceptions change when we relate it to the first perspective and the second perspective. Firstly, the needs of Mrs. McDonahue needs to be considered. There are some primal needs like feeding and defecating of hers, which she cannot be responsible for anymore. Hence, the responsibility of meeting those needs is the responsibility of her carers. However, there are other needs of hers which her carers are not being able to meet, which are her sexual needs. It is not the responsibility of her carers nor is it in the job profile of the carers to meet her sexual needs. But does this necessarily mean that her sexual needs are wrong and she doesn’t have the right to fulfil them by herself by masturbating. She is not harming anyone by using her own right to fulfil her sexual desire. However, it could be contended that her dulled sense of propriety, which is possibly a result of her Alzheimer's is a violation of the healthcare workers right, who only consented to work for her by caring for her.
Most of the academic work that has been done on ethics, rights and responsibilities come from establishing theories of universal human rights. However, it is not very difficult to locate the individual rights in the literature of human rights in general. Küng (1988) critiques the relation between the legal rights and the actual fulfilment of responsibility and says that human rights are not a reward that an individual gets when they fulfil their responsibility. All human beings are entitled to certain rights and in no way can these rights be taken away from them, they don’t have to ‘earn’ these rights by being valuable members to the society and then they can deserve to have basic human rights. The right to her own body and sexual pleasure is a right which every individual inherently has. In this sense, Mrs. McDonahue doesn’t have to deserve the right to pleasure herself as she sees fit, and the care workers should not physically restrain her from doing so. Restraining her so that she cannot masturbate would be a gross violation of her rights and in that way, would be a gross violation of human rights in general. What the healthcare workers could do, in this regard, is that they could do more to ensure she has privacy. For example, they could only assign female workers to care for her or they could ensure that the door to her room is kept shut. If they see Mrs. McDonahue engaging in that activity in a public space in the care room, they could gently lead her away and put her in a private space, so that the other residents don’t get bothered. This is a good way to ensure that Mrs. McDonahue doesn’t have her rights taken away from her. At the same time, the other residents of the care home have not consented to bear witness to something like this, and the healthcare workers also have a responsibility towards them, that they are also given the best care possible, in the endeavour to ensure Mrs. McDonahue’s rights, the care workers cannot possibly take away the rights of the other patients who are there because they want to provide Mrs. McDonahue with her rights.
Another important aspect to consider here is Mrs. McDonahue’s dignity and how to best preserve it while one is caring for her and also providing her with the rights that is due to her. Dignity is an important part of the general human rights that is owed to one person. Andorno (2014) speaks of two different kinds of dignity; the inherent human dignity and the moral dignity. According to Andorno, the first kind of dignity relates to the legal, bioethical dignity that is understood and applied in the universal sense. This is a dignity that is owed to everyone and no matter how reprehensible an individual is, they must be treated in a basic dignified manner. Moral dignity, alternatively, is a kind of dignity which depends on the behaviour of the person and not just based on the fact that the person is a human being. For example, every individual has a basic dignity which is owed to them. But if there is an individual who is distinguished in their profession or their services, it is very likely that they are going to be given a more dignified reception wherever they go. For example, consider a teacher and a Nobel laureate. A teacher, as an educator, is going to be respected and revered in society, based on the kind of services they provide. however, a Nobel laureate is going to be revered more, as the dignity that their achievements ask for is more. It has everything to do with the morality of that individual and how they have managed to follow a set of moral rules in life.
Considering this in the case of Mrs. McDonahue, one may contemplate if she is deserving of dignity based on the fact that she is inherently deserving of dignity because she is a human being or if she is deserving of dignity based on the actions she’s done in her life. In this case, some health workers may feel that it is not necessary to treat her with the same dignity and respect that they treat the other patients with as she is not very mindful of her own dignity. However, another argument could me made which postulates that since she has Alzheimer's and she isn’t fully aware of her surroundings and aware of the implications of her actions, she needs to be treated with more dignity as she wouldn’t have done this had she been of a healthy mind. In this respect, the health workers have the responsibility to supply her with more dignity in her day-to-day life because of the fact that, through no fault of her own, she has to do activities like defecation and masturbation in public, which is usually done in private by individuals. Because of this, it is very easy to see her as an undignified, almost like an individual who had no dignity to speak of.
The treatment of diseases like Alzheimer’s is tricky, as there is no cure to that particular disease. Caring for individuals with Alzheimer's is tricky and requires round the clock attention, which is why many individuals opt to keep their family members or friends who suffer from Alzheimer's in care homes, like the Firs Residential home. Heggestad et al (2015) found, after a categorical study into two care homes which cared for patients with dementia that residents don’t care as much about the medical treatment process as much as they care about being taken seriously as people and not getting treated like patients who are to be infantilised and objects which are merely duties to be fulfilled. An important part of being a good worker, in the eyes of the residents of the care home, is someone who is willing to sit down with them and listening to their problems. They care about not being treated as merely a sick individual who needs to be cleaned and fed and need to be given medicines and nourishment every once in a while. They care about being listened to and having their concerns registered by people. Hence, communication on a one-on-one basis forms an important part of the treatment process of a patient like that.
A problem which goes hand-in-hand with the care workers not being able to give adequate time to the patients is the fact that several of these residents have a lack of trained and experienced workers. Hence, the workers that are present are stretched thin between providing medical care to the residents and also intimately communicating with them in order to know their causes of discomfort. In Heggestad et al’s research, they came across a resident who was prone to discomfort throughout the day and usually, no worker could get her to calm down. There was only one worker who knew how to effectively make the resident feel better and it was only after her arrival that the resident could calm down. Hence, the inter-personal relationship that the resident had with the particular worker was the reason why she was more comfortable with that worker, and the reason the worker was able to reach that resident was because she invested a significant amount of time and energy into the resident and making sure that she was feeling alright.
It is important to note that while Mrs. McDonahue is non-responsive and does not seem to recognise anyone or register their communication with her, there is no way for the workers to know that she doesn’t comprehend what they are saying and/or she doesn’t understand what is being said to her. It is quite possible that Mrs. McDonahue does understand what is being said to her as communication and understanding are primal reactions. If she still possesses some primal reactions like her sexual instinct, it is possible she may still have her ability to understand and comprehend. In this case, if any behaviour of hers need remedying, the workers should communicate with her directly and make her understand that this kind of behaviour is inappropriate and needs to be changed. If they don’t communicate with her in a compassionate manner, while giving her the dignity she deserves, then it is possible that it will be detrimental to her health.
It is possible that the reason why it is so difficult to understand which approach must be taken with respect to Mrs. McDonahue’s problems is that perhaps no one has tried to communicate directly with her. It seems that the health care workers who work at the care home are approaching the problem with the perspective that Mrs. McDonahue is a “situation” that needs fixing. Even though Mrs. McDonahue remains largely unresponsive to any attempts at communicating and doesn’t respond to even her son, it is possible that through continuous attempts at communication with her, through the use of compassion and friendliness, she may be able to communicate with the workers. This is an important task as the working staff has gotten used to a non-responsive resident, then a lot of the day-to-day activities that take place with Mrs. McDonahue will be in accordance to that as well. For example, if a healthcare worker is feeding her, it is likely that they do not communicate with her because they are used to her not responding at all. In this scenario, it is possible that if a health care worker consistently takes the effort to talk to her and interact with her when she is feeding her or changing her, Mrs. McDonahue may eventually respond and talk to the health care worker. It is possible that Mrs. McDonahue may not respond in the most lucid manner, because her health condition does not allow her to be completely communicative as other normal people are.
Mrs. McDonahue is one of the thousands of people across the world who have the same condition and are not able to communicate their feelings like most people do. That does not mean that she is not deserving of being treated with the same kind of respect that a person who is not under care deserves. They should not be seen as merely an object or a duty to be fulfilled, care should be taken in order to meet their emotional as well as medical needs. A good way to do that is to make sure that the care home that they are a part of is not understaffed and workers are not stretched thin while fulfilling the needs of the residents. The workers need to spend adequate time in emotionally taking care of the residents, in addition to medically fulfilling their needs.
Question 2: In a reflective account, explain how this case study has contributed to your own learning, self-development and practice in understanding dignity and respect.
The objective that is meant to be achieved in this section is understanding how it can impact an individual to understand and analyse the case study which formed a part of the first question. The reflective account will be done using the Gibbs reflective cycle model. Gibbs reflective cycle was postulated first by psychologist Graham Gibbs, who elucidated in his book Learning by Doing about a model which places the individual in s structured cycle of reflection, whereby they think about things like their own feelings, evaluate and analyse it and then arrive at a conclusion.
Stage 1 consists of description; the study talks about Mrs. McDonahue who has Alzheimer’s and she relies on care workers to change her and do all her daily tasks. The point of contention arises when workers notice that she masturbates in her room everyday, and some argue that her pads should be fixed more tightly so she cannot access her private parts and some disagree on this. Stage 2 is consists of describing the feelings of the reader. Mrs. McDonahue was obviously oblivious of her bodily functions and her relations with her family members and friends. She is a woman who needs empathy and kindness, not judgment and unnecessary discipline. The workers are not in her position, hence cannot possibly tell what it is like to lose sense of propriety and control over one’s body. Perhaps, her masturbating is a way to take back some of that control.
Stage 3 is about evaluation of the incident. Reflecting on the particular incident, it can be inferred that clearly it was a moral debate that was at the centre of the incident and not a hygiene or health debate. The workers had been using pads for Mrs. MsDonahue on an everyday basis, there was unanimity on that. The objection arose from the stigma surrounding masturbation and that was the main divisive issue. Stage 4 consists of analysis. In this situation, essentially, one understands that kindness and compassion are qualities every human being deserves, despite their ability to communicate properly or not. Dignified behaviour is owed to everyone irrespective of their health condition.
Stage 5 consists of conclusion; in this case study, what can be safely concluded is that Mrs. McDonahue is not wrong in wanting to exercise her rights over her body in this respect and she shouldn’t be restricted physically. Finally, the stage 6, which consists of the action plan, suggests that Mrs. McDonahue should be given some privacy in her own space and maybe only female workers can be assigned to her. The workers who feel uncomfortable may have the option to not attend to her and attend to other patients. Additionally, compassionate and friendly conversation with her may make her understand eventually that some activities are only to be indulged in in the privacy of her own space.
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