Derogation of “duty of care” in favour of “choice”?

Abstract

Purpose -Chronic health conditions such as obesity and type 2 diabetes are higher in individuals with learning disabilities and significantly affect both quality of life and longevity. Healthy eating is an important factor in preventing these chronic conditions. The study reported here explored the role paid carers played in promoting healthy eating and how they managed the daily dilemma of balancing residents' right to make unhealthy food choices against carers' "duty of care". Design/methodology/approach -Semi-structured interviews were undertaken with a purposive sample of six residential paid carers. Interviews were transcribed and then analysed using a thematic approach.Findings -This small study highlights the challenges that staff face when balancing food choice against "duty of care". It highlights that when working with less able residents, carers are motivated by "best interests", to place boundaries and restrictions on food access and choice. It confirms previous studies that increased levels of choice for higher ability residents, often results in less healthy food choices. The study describes a lack of policy, guidance and specific training for paid carers which results in them using their personal subjective values as a basis for decision making. Originality/value -Since the publication of "Valuing People" (Department of Health, 2001) the core principles of residential services changed direction towards independence and choice. This study expands our knowledge on how paid carers make sense of the everyday conflicts between choice and "duty of care" when residents continue to make unhealthy food choices affecting their physical health.

Health promotion for people with intellectual disabilities – A concept analysis

“…Supporters of people with ID also have to deal with ethical dilemmas. One example is that they have to balance the need to respect the autonomous decisions of people with ID on the one hand and try to encourage their healthy lifestyle on the other . For example, staff working in residential settings often face conflicts when people with ID make unhealthy food choices that could negatively affect their health .…”

Repertoires of responsibility for diabetes management by adults with intellectual disabilities and those who support them

“…). Although the promotion of independence, autonomy and choice for this population is encouraged in UK health and social care policies (Department of Health ), supporters report experiencing ethical dilemmas when a tension arises between respecting autonomy and duty of care (Gill and Fazil ).…”

“I heard about the way the animals are treated and slaughtered, and I don't like it”—Attitudes of vegetarians or vegans who have learning disabilities

“…Some participants relied on staff support surrounding meal planning and preparation. Staff knowledge of public health messages is typically low (Gill & Fazil, 2013) and they often fail to manage/prevent obesity, influenced by factors such as a lack of nutritional training and a lack of cooking skills (Shoneye, 2012). For those participants who cooked independently, it was unclear where people were getting their health information from, how long ago they received the information and whether the views they held regarding nutrition were correct, as not every person with learning disabilities will have the ability to understand what a poor diet is or the long‐term consequences (Smyth & Bell, 2006).…”

“…The diets of people with learning disabilities are often influenced by their staffs' own beliefs and attitudes (Smyth & Bell, 2006). Support staff frequently draw on their own life experiences when offering food choices and advice surrounding meals (Gill & Fazil, 2013). It is unknown what percentage of support staff do not eat meat.…”

“…It is unknown what percentage of support staff do not eat meat. However, the findings of Smyth & Bell (2006) and Gill & Fazil (2013) suggests that it would be more likely that vegetarian staff would offer a meat‐free meal, compared with meat‐eating staff, as an option based on their attitudes and beliefs. However, no research exists which explores meat consumption among people with learning disabilities, or the influence of staff who are vegetarian, making it unclear whether or how often people with learning disabilities are offered or served vegetarian meals.…”