I was recently part of a discussion that focused around disabilities and social inclusion and since then I’ve had a bunch of thought rattling around in my mind about how we as social workers determine what is in someone’s “best interests.”
The basis of all of these thoughts comes down to this: at what point is a person considered so vulnerable and unable to “speak for themselves” that it is appropriate for the service professional or social worker to act against their own code of ethic (advocating for self-determination) and take away the option of choice because it was determined to be against that person’s “self-interest?”
We must negotiate that line or continuum, not just a daily basis, but multiple times in our interactions with, and decisions regarding, vulnerable persons. Our professions are pretty good at giving lip service to “empowerment” and “advocacy” and “self-determination” until we decide that the “client” is not acting in their “best interest” (according to OUR standards, of course) and then we step in to “protect” them.
Maybe this subjectivity is less ethically “sticky” if the client is causing harm either to him/herself or to someone else; but what about those areas in which harm isn’t exactly evident or in which the harm to self or others is much more subtle? For example, this discussion centered around social inclusion and persons with disabilities. More specifically, the conversation began with ways in which direct support staff or professionals working with clients who exhibit these characteristics can “encourage” social inclusion in the greater community. Someone in this group stated they thought that some of the examples given were more coercive than “an encouragement” and that the people in question (clients) did not appear to have given consent to enter these “friendships” with community members (in fact, it seemed more about the community members who volunteered/mentored the person with the disability than an equal relationship).
Several years ago I worked in a residential group home for persons with disabilities. One of my duties was to take the residents out into the community – for example, to movies, the mall, the library, to parks, etc. Our job was not to “help” the residents “make” friends, our job was to facilitate their interactions in the community. Some of the residents did not want to have friends, in the community or otherwise. They would tell you directly that they had all their social needs met by family members who visited and occasional (and rare) conversations with staff. Part of the lack of interest in socialization had to do with their disabilities, and other parts may have been due to personality or temperament. After the discussion from last week, now I wonder what I would have done if part of my job duties had been to “find” friends for the residents. There seems to be no guidelines for this – helping our vulnerable clients “make friends.” What is the power dynamic in these relationships, when we are basically encouraging volunteer mentors from the community and asking them to befriend persons who are vulnerable?
Either way, if forcing residents who have low thresholds for social interaction and engagement makes them feel bad, do we make them anyway? Could one argue that a client is self-harming [emotionally] if it is determined that a person needs social interaction and s/he refuses?
How do we facilitate choices for clients while also determining what’s in their best interests and subtly (or not so subtly) imposing our views on them? I’m not talking about social exclusion here – I am not advocating that we do not consider the social needs of the people we work with. I am asking about those clients who have low thresholds for social interaction and how much we force it upon them, because we think it is in their best interests?