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Self-determination and Paternalism in Community Care: Practice and Prospects
Authors:CLARK  CHRIS
Abstract:Correspondence to Dr Chris Clark, Senior Lecturer in Social Work, Adam Ferguson Building, George Square, Edinburgh EH8 9LL, Email: Chris.Clark{at}ed.ac.uk Summary Self-determination is long established as a key principle ofsocial work ethics, but has seldom been the subject of empiricalresearch. This article reports on a qualitative study of theprinciples and beliefs of community care social workers in alocal authority. It is shown that, while workers retain strongattachment to traditional ideas about self-determination, theyalso appreciate that paternalistic intervention is sometimesjustified. The more recently fashionable concept of empowermentappears to have had little useful impact. The paper argues that,while the persistence of self-determination is a strength ofsocial work and should be defended, traditional practice ethicsare weak on the political issues embedded in community care.Five key issues are identified: the threat to individualizedservice under care management; the problematic determinationof mental competence; social ambivalence about the extent offamily responsibility for dependent adults; the threat to equityarising from variable interpretations of self-determination;and the excessively elastic interpretation of empowerment.
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