tAutonomy Vs.
Paternalism In Mental Health Treatmen EssaytThe assignment for this Ethics class was to review Mr. Jacob’s treatment,as described by the New York State Commission on Quality of Care for theMentally disabled (1994). The class was further asked to comment on the majorissues for each of the three perspectives. The agencies, family and reviewboard were to be included. This student will begin with a fourth perspective;that of Mr.
Gordon. In the Matter of Jacob Gordon (1994), is the story of the last eight yearsof a psychiatrically disabled man’s life. Mr. Gordon appeared to vacillatebetween striving for autonomy and accepting the support of his family. Unfortunately, it appeared by this account that the families support was notsynonymous with autonomy. It did not appear that Mr.
Gordon had ever desired orsought agency intervention for himself. Mr. Gordon’s association with themental health system appeared to be marked by power and control issues. ;Consumers/ex-patients often report a feeling of ;invisibility;; they sense thattheir views and desires do not matter (Carling, 1995, p.
79 ). ;The commission’s report (1995) spoke of several incidences where Mr. Gordoneluded to his desire for autonomy. Mr. Gordon did not wish to live in asupervised setting. Mr.
Gordon did not wish to attend group day treatmentsettings. Mr. Gordon did not wish to use medication in the treatment of hismental health disorder. Without medication his behavior was deemed unacceptableand did not permit him the opportunity to have any of these choices. “Choice isa right-not a privilege to be afforded by good behavior (Penny, 1994, p. 29).
“Mr. Gordon’s right of choice was limited even though he lived in his apartmentindependently. The condition of his apartment was scrutinized. His medicationwas closely monitored; sometimes to the degree that he was directed to leave hishome to receive medication that was given to him crushed, in an attempt toinsure it’s ingestion.
“Even peoples liberties in a highly controlled board andcare home may be scarcely greater than in a hospital ward (Rubenstien, 1994,p. 54). ” In Mr. Gordon’s case even within the sanctity of his own home, hisliberties were scarcely greater than in a hospital ward.
Other than his autonomy the second issue for Mr. Gordon appears to be theneed for safety and support. For this, Mr. Gordon turned to his family. Thereport (1994) points out that Mr. Gordon requested his mother be limited in herability to access personal information.
He continued to need her support andassistance although this met she continued to be overly involved in his life. It was his mother he turned to when he had problems with a roommate. It was hismother who was utilized when Mr. Gordon was less compliant. It was Mr. Gordon’sfamily who assured that he had continued mental health counseling and services.
It was also Mr. Gordon’s family who appeared to be the focal point of any plansfor Mr. Gordon. ;.
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expectations, soon to be dashed by programs more devotedto servicing neurotic families than people with schizophrenia; (Rubenstien, 1994,p. 55). Mr. Gordon remained safe and close to his family by relinquishing hisautonomy. Mr. Gordon’s safety was the most important issue for the family.
Secondarily to his safety, Mr. Gordon’s family wished him to have theopportunity to participate in programming that would assist in his wellness. For Mr. Gordon’s family, wellness seemed to equate to a standard of behaviorthat his mother personally viewed as normal. The family were not bound to any code of ethics or compelled to understandtheir biases or prejudices in their son’s case.
Certainly, to say that thefamily operated on the premise of paternalism is an understatement. Ethically,the Gordon’s believed that they were the most justified to speak in the bestinterests of their son. The energy that the Gordon’s put into advocating forwhat they believed, was in their son’s best interest, is a testimony to thedepth of the feelings they had for their son. The agencies primary issues appeared to be their liability andresponsibility. Looking at the commission’s report and attached responses fromagencies (1995), it appears as though all of the agencies and practitionersinvolved were overly respectful of the involvement of Mr.
Gordon’s family. Thisover-involvement with Mr. Gordon’s mother was understandable when it wasdisclosed that she had complained to state officials, whenever agencies did notrespond in a way that she believed to be acceptable. It appears as though Mrs.Gordon .
