Abstract
“Lawyers want it both ways: people must have their liberty but nobody can die”(Series, email Sept 2014): Exploring the ethical implications of Article Two (HRA, 1998) on mental health professionals.
A sanguine principle of Article Two of the Human Rights Act (1998) is that all patients have the “right to life”. Coroners are now duty bound to investigate a death where a person has been in the care of the ‘the state’. Furthermore it allows distressed relatives recourse, via the courts, to establish how ‘the state’ deprived their relative of the right to live. Since the case of Rabone v Pennine Care NHS Foundation Trust (2012) there has been an increase in Article Two cases as litigators embrace the opportunities to apportion blame when a person has chosen to commit suicide.
It is ironic then that this principle could damage mental health services in the longer term. In an increasingly contentious environment, mental health practitioners must contend with ethical dilemmas on daily basis surrounding risk. In particular when working with people who may, or may not have, made threats against their lives; and who may, or may not, have a mental illness. There seems to be a cultural assumption that all patients with a mental health history lack the capacity to make rational decisions about their future unlike those with a physical illness/disability (Callaghan et al 2013).
In a world where litigators and the media increasingly vilify health professionals (Leigh, 2013), what impact does this have on mental health practitioners who deal with the issue of suicidality on a daily basis? Contrary to popular belief the Mental Health Act (2007) is not just a piece of legislation to coerce people into involuntary treatment (Callaghan et al 2013, MacGregor-Morris et al, 2001). It also plays a strong role in protecting people from inappropriate intervention thereby enabling them to maintain their liberty and autonomy. So how do practitioners manage the daily conflicts that arise from working within the government endorsed Recovery Model (Repper and Perkins, 2003)?
What happens to practitioners if, despite all efforts, their patient commits suicide and they then find themselves being accused of depriving the patient of his right to live? What effect does this have on clinical decision making when mental health professionals begin to feel their own livelihood and professionalism is removed; with a fear of reprisal potentially jeopardising their own lives (Large and Neilsson, 2011)? How do they balance the daily dilemma of allowing their patient to be proactive in their care when there will always be a risk that some patients will chose an alternative unspoken pathway?
Using the method of auto-ethnography, this paper will discuss the moral, ethical and professional dilemmas that confront the mental health practitioner who, on a daily basis, tussles with the conflicting expectations of the Recovery Model whilst simultaneously navigating the litigious environment that is rapidly becoming a cultural identity within our National Health Service.
Biography
Ms Morrissey is a qualified Occupational Therapist with more years of practice than she cares to remember under her belt! She is currently employed as a Mental Health Practitioner and has spent the last four years working on the frontline of acute adult mental health in a crisis response team. She has always been alive and interested in professional tensions and ethical conflict that daily practice invokes but is presently concerned by the impact of Article Two (HRA 1998) on clinical practice and patient care. She has an MSc and has published in the past.
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