Duty of Care vs Choice

Every care provider and person working for that provider has a duty of care towards the individual being supported, the service user. And every service user has choice. The tension between duty of care and choice becomes more significant when somebody becomes an adult and are in care.

When someone is at school or college, even if they are technically an adult, they are essentially buying into – or ‘signing up to’ – a set programme of activities in a structured environment. This means they are likely to want to do what they are encouraged to do without much opposition (although in some cases we have come across, they have actually been left to their own devices and outside of the group programme, which does bring into question why they were placed in the first place.)

When they come to leave that environment and are an adult, they have the choice about whether they want to do something or not do something. Unlike children, adults cannot be forced to do anything.

What is in Someone’s ‘Best Interests’

None of us really want to go out when it is a nasty day, when it is cold and raining so our natural inclination is to say ‘no’. But if it is in someone’s best interests to go out because they need to have exercise for health reasons or they need to have a change of environment once a day to maintain their equilibrium, then it’s obviously in their best interest to be encouraged to go out and for staff to facilitate this happens.

Asking the Question in the Right Way

It’s very easy to phrase a question that gives choice, but that question can be manipulated, or asked in such a way as to give the result the person asking the question wants.

Firstly, it’s all about the intentions of the person actually asking the question. Secondly, it’s about their ability to phrase the question to get the answer that they want.

If they are a positive individual and they want the best for the service user, (which might not be the best for them personally as an individual supporting that service user because it might require them to do things and be active and so on) they would phrase the question “do you want to go swimming or do you want to go bowling” on the basis that it will be one or the other and they will get a response to one or the other so they will achieve an activity.

If they are a poorly motivated member of staff or alternatively if they are a poorly trained member of staff they might phrase the question, “do you want to go swimming” to which they will get the answer “no”. Their motivation for doing that might be that actually they want to hear ‘no’ because it’s easier not to go out than to go out, or actually their motivation is that they do want to achieve the right thing for the individual but as a member of staff they’ve been let down by the training that they have received.

Creating Positive Environments

As a provider and on an individual staff level, everyone needs to work towards creating a positive environment whereby individuals are encouraged and supported to do things that they would like to do but are also in their best interest. It means getting the outcomes that are best for the person and not the member of staff.

When ‘Choice’ Becomes an Excuse

All too often, some providers will use ‘choice’ as an excuse not to do things that might be in the best interests of the individual. Failure to deliver responsible duty of care in this context, soon equates to warehousing the individual.

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