Autonomy V Paternalism In Mental Health Treatment, Outline And Review Of The Nys Case On Jacob Gordon

2617 words - 10 pages

The assignment for this Ethics class was to review Mr. Jacob's treatment, as described by theNew York State Commission on Quality of Care for the Mentally disabled (1994). The class wasfurther asked to comment on the major issues for each of the three perspectives. The agencies,family and review board 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 years of a psychiatricallydisabled man's life. Mr. Gordon appeared to vacillate between striving for autonomy andaccepting the support of his family. Unfortunately, it appeared by this account that the familiessupport was not synonymous with autonomy. It did not appear that Mr. Gordon had ever desiredor sought agency intervention for himself. Mr. Gordon's association with the mental healthsystem appeared to be marked by power and control issues. 'Consumers/ex-patients often report afeeling of 'invisibility'; they sense that their views and desires do not matter (Carling, 1995, p.79 ).'The commission's report (1995) spoke of several incidences where Mr. Gordon eluded to hisdesire for autonomy. Mr. Gordon did not wish to live in a supervised setting. Mr. Gordon did notwish to attend group day treatment settings. Mr. Gordon did not wish to use medication in thetreatment of his mental health disorder. Without medication his behavior was deemedunacceptable and did not permit him the opportunity to have any of these choices. 'Choice is aright-not a privilege to be afforded by good behavior (Penny, 1994, p. 29).' Mr. Gordon's right ofchoice was limited even though he lived in his apartment independently. The condition of hisapartment was scrutinized. His medication was closely monitored; sometimes to the degree that hewas directed to leave his home to receive medication that was given to him crushed, in an attemptto insure it's ingestion. 'Even peoples liberties in a highly controlled board and care home may bescarcely greater than in a hospital ward (Rubenstien, 1994, p.54).' In Mr. Gordon's case evenwithin the sanctity of his own home, his liberties were scarcely greater than in a hospital ward.Other than his autonomy the second issue for Mr. Gordon appears to be the need for safetyand support. For this, Mr. Gordon turned to his family. The report (1994) points out that Mr.Gordon requested his mother be limited in her ability to access personal information. Hecontinued to need her support and assistance although this met she continued to be overlyinvolved in his life. It was his mother he turned to when he had problems with a roommate. Itwas his mother 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 plans for Mr. Gordon.'......expectations, soon to be dashed by programs more devoted to servicing neurotic families thanpeople...

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