'Society has disabled Marcus' examine the issue of disablism discussed in the presentation with regard to anti-discriminatory practice and professional ethics.

Student ID: K0227637

This assignment takes as its starting point the presentation entitled ‘Society has disabled Marcus’ delivered on 19th March 2003 as a required element of the module Applied Professional Ethics (see Appendix A). It aims to examine the issue of disablism discussed in the presentation with regard to anti-discriminatory practice and professional ethics. Initially the article will seek to outline the social model of disability, which holds anti-discriminatory practice at its heart. It will then go on to consider this against current social work practices and social work codes of conduct, especially in the area of Mental Health. Ethical theories will be used both to illustrate the origins of ethics in social work and their applied use in cases of ethical conflict or dilemma.

Traditionally disability has been seen in terms of the medical model (Thompson, 2001) where service users have been given labels and defined wholly by their illness or disability rather than as fellow human beings with diverse needs. The following quote from the Gypsy Survey (1993 cited by Dalrymple & Burke, 1995, p.15) cuts to the core of labels and stereotyping. While it refers to Gypsy life one could easily substitute any label relating to any minority group.

“When I am asked if I am a ‘Real Gypsy’ my answer is this: I am flesh and blood, I feel pain, I feel joy, I love, I hate, cut me I bleed, I am a real human being living in today’s world who happens to be a Gypsy. Not some stereotype that fits misinformed people’s ideas of what a Gypsy should be. “

The advent of the social model of disability and legislation such as the Disability Discrimination Act (1995) has attempted to redress the balance through promotion of the idea that many of the difficulties facing people with disabilities are imposed by society and are in fact a result of [unlawful] discrimination:

“the reality of the lives of disabled people is that they are often barred from many leisure activities or from using public transport, and are discriminated against in employment.” Dalrymple & Burke (1995, p.110)

Furthermore It has been said that the stigma associated with being a client reinforces the widespread assumption that impaired people are in essence incapable of being full members of society (Morris, 1991). It is therefore necessary for social workers to work in such a way that empowers users by assisting them to increase the control they have over their lives. This needs to happen not only at the personal level but also at the cultural and societal level (Thompson, 2001). A useful example of this is a recent case reported in Community Care (Mar 19th, 2003) of S, an 18-year-old autistic male who was in need of a kidney transplant. The Hospital trust responsible for his care had ruled out a kidney transplant on the basis of him having ‘no real future potential for intellectual development’. Does this mean that people should effectively be left to die simply because they have impaired cognitive functioning? In this case Social Services worked in partnership with S and his family and successfully advocated for S in a court of law where the judge ruled that the trust’s decision was a breach of S’s human rights. Thus S was granted his right to life and on a wider scale it is seen as a landmark for other cases involving discrimination on the basis of disability.

As can be seen from the above case an important aspect of anti-discriminatory practice is that of autonomy – respect for the person and self-determination. This concept is highlighted in The Social Work Code of Practice (GSCC, 2002). In the case of Marcus a lack of partnership working and the conflict between the needs of Marcus and those of his mother have led to a denial of Marcus’ autonomy and his ability to make choices. Services have failed to treat him as an individual and have not delivered on their duty of care which they are bound to ...

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The principle of autonomy comes from Kantian or deontological theory. Before exploration of ethical theory is pursued it is necessary to first look at what we mean by ethics and the relevance to social work.

Siporin, 1982 (cited in Gray, 1996) suggests that Professional ethics refer to

“the moral philosophy – the set of values, beliefs and normative rules – that prescribes and explains the obligations for good, right conduct on the part of a professions members”

This quote neatly encapsulates ethical theory, the values implicit in it and the purpose of ethical codes. It is only recently that Social Work has had an official code of practice. Prior to this members of The British Association of Social Workers (of which membership is voluntary) have been expected to uphold BASW’s prescribed Code of Conduct. However the GSCC Codes of Practice for Social Work (2002) have been hailed as a major breakthrough for the profession, in its quest for recognition as a professional vocation.

“It is not often that people in the social care sector get what they hope for. But now a 20-year-old dream has come true.” Community Care (Oct, 2002)

As mentioned earlier autonomy, choice and self-determination are central to the codes and can be seen as rooted in Kant’s deontological theory. Kant saw human beings as creatures of reason (Clark, 2000 p.71) and therefore capable of making choices between right and wrong action. In essence his theory can be defined as “do unto others only that which you would wish done unto you”. It is important to note, though, that his theory did not extend to persons lacking capacity by which he meant children and those with mental impairment or illness (Clark 2000, p.145). Noel Timms (1983 cited by Horne, 1999, p.7) comments that some have seen ‘respect for person’ as discriminatory towards minority groups. However I would argue that few social workers today would adhere to this extremist view and that the question would centre on how much capacity individuals have, rather than it being a strict dichotomy between ‘capacity’ and ‘non-capacity’. The notion of capacity can be seen to be important with reference to mental health law, which is discussed later.

In addition Kant’s theory does not allow for ethical conflicts, for example between the autonomy of an individual and the interests of society. Similarly the codes of conduct while upholding client autonomy also refer to balancing this with the best interests of society but do not prescribe a solution which causes problems in that

“Some of the most complicated ethical dilemmas involve a conflict between what is best for the person and what is good for the system or community”

(Curtis & Diamond, 1997 cited by Brown & Wirak)

The counter argument to Deontology is given by Utilitarianism whose main proponents include Jeremy Bentham and John Stuart Mills (Wilmot, 1997). The basic principle of utilitarianism can be expressed as “the greatest good for the greatest number of people”. In contrast with Kantian theory utilitarianism relies on the consequences of an action rather than the means employed. If we remember the case of S, outlined earlier, then we can see how agencies utilise utilitarianism to justify their actions with reference to resources. A kidney transplant is extremely costly and there is a shortage of organs available for transplant. Meanwhile there are many people who need transplants and could be considered to have greater potential for quality of life. While this is clearly discriminatory it is an unfortunate reality that resources are limited and that most systems of distribution will discriminate in some way.

Ethics and codes of practice also need to be considered in conjunction with relevant law as demonstrated by the use of the Human Rights Act (1998) in S’s case. An area in which there is considerable overlap between ethics, both Kantian and consequentialist, and law is that of Mental Health. Within this area there is a frequent need to balance the clients’ autonomy (Kant) with that of the interests of society (Utilitarianism). This conflict is highly apparent in Mental Health law whereby an individual can be detained against their wishes if there is a perceived risk to either the client themselves or to public safety (Mental Health Act, 1983). Recently this issue has been brought to the forefront by the Draft Amendment to the Mental Health Act (1983). For the first time in recent history all categories of mental health personnel have joined together in protest against what some have called draconian measures. BASW (2002), in response to the consultation on the draft mental health bill, suggests that if the bill is not seriously revised then it may, in the future, recommend that social workers do not take on the role of the Approved Mental Health Professional (AMHP) which is due to replace the Approved Social Worker (ASW) role. This is largely due to the fact that the criteria for compulsion in the draft bill is so wide that

“…anyone referred to a secondary service for whatever reason, who has a treatable condition and who declines to accept the consultant’s advice, will be liable to compulsory action, regardless of their capacity” (BASW, 2002)

It transforms the role into one of policing and control on the grounds of public safety and gives no consideration to the benefits to the patient. This would contravene both the BASW Code of ethics and the GSCC code of conduct, which promote the best interests of society in conjunction with the service user’s autonomy. In addition it takes away the present discretion that is available in the current legislation in terms of risk and in my opinion makes a mockery of sections 1.3, 1.6, 3.1, 4.1 of the GSCC code. There is also concern that it may breach the Human Rights Act (1998) (Depression Alliance, 2002). In essence the draft bill seems to run contrary to professional codes of conduct, ethical practice and also to the government’s own publication - The National Service Framework for Mental Health (1999).

This article does not wish to suggest that compulsion should never be used to detain those experiencing acute mental distress or that the best interests of society be ignored. Instead it is about looking for ways to effect the least harmful or restrictive result for the maximum benefit for all involved. This often requires innovative thinking and a true commitment to working in partnership. For example Hodge (1997 cited by Brown & Wirak) points out that the questions “What can I do to help you remember to take your medicine?” or “Which of these supports is most helpful” are distinctly different to “I’m going to have your medicine delivered every day”. In the area of detainment under mental health law this might be achieved through the use of advance statements/directives outlining the service users wishes in relation to treatment. However it is important to note that at present these can still be overruled through use of the mental health act (The Mental Health Foundation, 2002). Working in partnership with Marcus’ mother and consideration of her mental health, perhaps with regard to informal admission may have led to a resolution that maximised both her autonomy and that of Marcus.

In conclusion this assignment has attempted to look at the issues of disability and anti-discriminatory practice with reference to ethics and associated law within the social work and allied professions. In doing so it had highlighted the conflicts that are inherent in social work practice and the difficulties that arise in finding solution to these conflicts. Unfortunately it has not been possible to consider further alternative theories within this assignment but this is not to deny their existence. Social work has been, is and always will be a finely tuned balancing act which relies on the integrity of its members while constantly seeking to further its development and maximise resources available to service users without expense to individuals or marginalised groups. In doing so the profession needs to remain true to its values so that it may actively promote change at all levels of the system and reduce discrimination and oppression. While ethical codes can assist workers in striving for this goal it is worth remembering that it will take more than ethical codes to make social work ethical (Gray, 1996).

Appendix A – Case study used in Presentation for module on Professional Ethics on 19th March 2003.

The Case of Marcus:

Marcus is 24 years old, blind, deaf and has learning difficulties.

Since he left special school at the age of 19, he has live at home and been caref for by his mother. Over the last two years it has become increasingly difficult to visit Marcus; his mother is very agrressive and refuses to allow anyone to enter the house. Last year you were so concerned that you managed to get Marcus admitted to psychiatric hospital for assessment, but he was discharged three days later, after his mother pleaded with the psychiatrist to let him return home.

You understand from Marcus’ elder sister that he spends all his time lying on the sofa in the front rom in squalid conditions and she is concerned about the standard of care being provide for him by his mother, who she thinks is mentally ill.

The house is in a bad state of disrepair and is owned by the local authority.

Adapted from the case of Beverly Lewis cited in Vernon, P. (1998) Social Work and the Law, London: Butterworths.

Appendix B - References

BASW (1996) The Code of Ethics for Social Work, ()

BASW (2002) Response to the Consultation on the Draft Mental Health Bill, ()

Brayne, H., Martin, G. & Carr, H.(2001) Law for Social Workers (7th Ed.) Oxford: Oxford University Press.

Clark, C. (2000) Social Work Ethics: Politics, Principles and Practice. Basingstoke: MacMillan.

Community Care (2002) Rebirth of a Profession, Community Care, Oct 2002.

Corey, G., Corey M.S. and Callahan, P.(1993) Issues and ethics in the Helping Professions (4th ed.) California: Brook Cole Publishing.

Dalrymple, J. and Burke, B. (1995) Anti-Opressive Practice: Social Care and the Law. Maidenhead: Open University Press

Depression Alliance (2002) Response to the Draft Mental Health Bill, 2002, ()

DoH (2002) Mental Health Bill Consultation Document. HMSO.

DoH (1999) National Service Framework for Mental Health. HMSO

Ford, G.(2001) Ethical Reasoning in the Mental Health Professions. London: CRC Press.

Fulford, B.(2003) National Framework of Values for Mental Health. Conference online – The Role of Values in Mental Health. The Connects Conference Centre. ()

Gray, M. (1996) Moral Theory for Social Work. Social Work, 32 (4)

GSCC (2002) Codes of Practice for Social Care Workers and Employers, London: GSCC

Horne, M. (1999) Values in Social Work (2nd Ed.) Aldershot: Ashgate

MHF (2002). Advance Statements in Mental Health. Updates. 4(2)

Morris, J. (1991) Pride against Prejudice. London: The Women’s Press.

Thompson, N. (2001) Anti-discriminatory Practice (3rd Ed.) Basingstoke: Palgrave/BASW

Kenny, C. (2003) Second class treatment outlawed by Court. Community Care, 19/03/03.

Wilmot, S. (1997) The Ethics of Community Care. London: Cassell

SW1005 Applied Professional Ethics