Social work and end-of-life care

Social work is important in end-of-life care

Accepting the risks of people living in their own homes – a Court of Protection case

with 2 comments

Any social worker with older people will have experienced the situation where the extent of care someone needs makes them unhappy: nobody likes to be dependent, and often people have to put up with it. But this is also sometimes about the end of life. It’s not possible to work in end-of-life care for long without coming across someone who wants to go home, but is putting themselves at risk by doing so, because their care cannot adequately be provided at home. The professionals often react to this by refusing to accept the risks. A Court of Protection case looked at a deprivation of liberty case that raises some of these issues.

The case was unusual in that M, a woman of 67 years, was only considered not to have mental capacity in relation to her diabetes care; she was fine in other aspects of her life. There was a record of her going home, not managing her diabetes properly and having to be expensively re-admitted to hospital. The CCG (clinical commissioning group) paying for her care would not fund 24 hour care at home,which would probably be too intrusive for M anyway, and regular nurse and carer visits were not enough to make sure she kept to her regime, so they were paying for her to be in a care home, where her condition and diabetes management had improved. But M found this particularly unpleasant, being a private person who disliked a communal lifestyle. Many of the other residents were much older and had dementia – not attractive company for a youngish woman. She also had a partner who supported her, but was not living full-time with her and could not provide for all her care needs. It seemed she was being deprived of her liberty simply to keep her alive for as long as possible. One of the witnesses said: ‘…at the care home there is almost complete certainty of physical safety at the cost of the happiness of M’ (para 32).

The decision was about the balance of risks: should she put up with a unwanted lifestyle simply in order to have her life preserved? The judge’s conclusion is:

In M’s case there is little to be said for a solution that attempts, without any guarantee of success, to preserve for her a daily life without meaning or happiness and which she, with some justification, regards as insupportable (para 38).

So he allowed some time for arrangements to be made and then withdrew authority for the deprivation of liberty order.

The judge makes the point (at para 41) that he accepts that the court should take responsibility for such decisions rather than the professionals, whose duty of care means that they should not have to make this judgement. I’m afraid I’m a bit more critical of the professionals. What is a care professional for, but to help service users balance their various needs? One of the lacks in this case seems to me to be a social work perspective which sees people holistically, not as patients having services delivered, but as human beings living a social life with relationships that are important in themselves, and whose preferences for the kind of life they want to lead having an important place in the decision-making. Also, I can’t help imagining that the CCG was not wanting a return home because it would have to pay the expenses for re-stabilising her care in hospital again if the return home failed – the care home was the cheap option. Perhaps improving the quality of care and the relationships between its staff and M and her partner was too much like expensive hard work.

The judge also commented how good it was that the judge at first instance – this was an appeal – had visited M at the care home and listened to her views. He said:

The visit has therefore had the dual purpose of informing the court of M’s views and of making M feel connected to the proceedings without putting her into the stressful position of having to come to court in person. I commend this as an approach that may be of value in other cases of this kind (para 42).

So let’s have no nonsense about courts not stirring from their imposing buildings and going out into the real world.

Link to a legal commentary. This lists the law firm’s newsletters; scroll down and click on: Mental Capacity Law Newsletter – December 2013 mc_law_newsletter_december_20132.pdf

Link to the report of the court case.


Written by Malcolm Payne

8 January 2014 at 1:20 pm

2 Responses

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  1. Thanks for posting this, Malcolm — it will be useful in teaching and supervision. Tony

    Tony Bibus

    9 January 2014 at 7:17 pm

  2. This is excellent example of good practice! I will work on this case with my students.

    Jana Pružinská

    14 January 2014 at 10:20 am

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