Reflections on Placement

One of the struggles I am finding with doing my placement in a clinical setting is remembering clients have the right to make their own decisions around their healthcare, even when it goes against the advice of their doctors. When elderly patients are socially isolated and have a number of other issues that makes their ability to remain at home, unassisted dangerous. However they may feel that they are still able to live independently and refuse any suggestions or interventions to make their choice to remain at home with help a safer option.

I have a client at the moment that was found in his home by a neighbour, slumped in his hallway on the floor, unconscious. At the age of 67 he weighs 42 kilos and is severely malnourished. He admits that he doesn’t eat very healthy foods and in fact hadn’t eaten in quite some time when he was found. While I felt that my heart was breaking for this elderly, kind and gentle man who could possibly have a healthier life at home with the service of meals on wheels that would provide food delivered to his home. He refused to consider the idea because he says he doesn’t want to burden or depend on anyone else. He has been assessed and found to be competent to make his own decisions.

According to Bowles et al. (2006), client self-determination is an ideology social workers should follow that allows clients a free, independent choice despite pressures from others. The internal struggle I am finding is between duty of care to aid and assist those who are vulnerable while respecting a client’s autonomy and self-determination. It is their choice to accept or decline services. All we as professionals can do is to make sure our clients have all the information available to make an informed decision. This has also something I find I have to reflect on frequently to remind myself that clients can make their own decisions and sometimes I will not think they are the right decisions but I have to keep my personal thoughts and feeling out of my practice.

I had to reflect on this a lot with a different client who was self discharging against medical advice. He had decided to stop medical intervention and return home even though stopping his treatment meant that he would not survive his condition. I took his decision personal for awhile until I had time to reflect on the situation and remind myself that even thought I may not agree with a decision, if the client is competent and understands the risks then I have a professional duty to respect their decisions.